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Centre for Evidence-
Based Medicine

Anoxic Brain Injury: Estimating Recovery

Clinical Bottom Line

Pt who have no motor response 3 days after hypoxic stroke following cardiac arrest have 0% chance of good neurologic outcome at 1 year.

Citation

Edgren E, Hedstrand U, Sutton-Tyrell K, Safar P, and BRCTI study group.
Assessment of neurological prognosis in comatose survivors of cardiac arrest.
Lancet 1994;343:1055-59.

Clinical Question

In patients without motor response three days after hypoxic stroke, what is the probability of a good neurologic recovery (cerebral performance category[CPC] 1 or 2).

The Study

The authors studies 262 patients with hypoxic coma following cardiac arrest and the cohort was drawn from a multicenter clinical trial of thiopentone (Brain Resuscitation Clinical Trials Group). Patients were examined daily and followed for one year. The primary outcome was good neurologic recovery at one year. Forty-three patients had no motor response on day 3.

The Evidence

Prognostic factor Outcome1 Time Measure 95% CI2
No motor response CPC 1 or 2 Day 3 0% (0/43) -2% to 2%
No pupil light response CPC 1 or 2 Day 1 18% (16/89) 10% - 26%
No pupil light response No pupil light response Day 3 0% (0/18) -3% to 3%
  1. good neurologic outcome defined as cerebral performance categories (CPC) 1 or 2.
  2. 0.005 used as the event rate to calculate the 95% CI

Comments

  1. Study suggests that absence of motor response on day 3 is the best predictor of poor outcome. However, absence of pupil light response also helps in predicting poor outcome.
  2. They had a well defined cohort with adequate follow up however it is unclear if person evaluating the outcome was blinded to neuro exam.
  3. They did not evaluate the model in an independent test set of patients.

Appraised By

Pronovost, 1999

Expiry Date

2000

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