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Prognosis of coma after therapeutic hypothermia: A prospective cohort study. / Bouwes, Aline; Binnekade, Jan M.; Kuiper, Michael A.; Bosch, Frank H.; Zandstra, Durk F.; Toornvliet, Arnoud C.; Biemond, Hazra S.; Kors, Bas M.; Koelman, Johannes H. T. M.; Verbeek, Marcel M.; Weinstein, Henry C.; Hijdra, Albert; Horn, Janneke.

In: Annals of neurology, Vol. 71, No. 2, 2012, p. 206-212.

Research output: Contribution to journalArticleAcademicpeer-review

Harvard

Bouwes, A, Binnekade, JM, Kuiper, MA, Bosch, FH, Zandstra, DF, Toornvliet, AC, Biemond, HS, Kors, BM, Koelman, JHTM, Verbeek, MM, Weinstein, HC, Hijdra, A & Horn, J 2012, 'Prognosis of coma after therapeutic hypothermia: A prospective cohort study', Annals of neurology, vol. 71, no. 2, pp. 206-212. https://doi.org/10.1002/ana.22632

APA

Bouwes, A., Binnekade, J. M., Kuiper, M. A., Bosch, F. H., Zandstra, D. F., Toornvliet, A. C., Biemond, H. S., Kors, B. M., Koelman, J. H. T. M., Verbeek, M. M., Weinstein, H. C., Hijdra, A., & Horn, J. (2012). Prognosis of coma after therapeutic hypothermia: A prospective cohort study. Annals of neurology, 71(2), 206-212. https://doi.org/10.1002/ana.22632

Vancouver

Bouwes A, Binnekade JM, Kuiper MA, Bosch FH, Zandstra DF, Toornvliet AC et al. Prognosis of coma after therapeutic hypothermia: A prospective cohort study. Annals of neurology. 2012;71(2):206-212. https://doi.org/10.1002/ana.22632

Author

Bouwes, Aline ; Binnekade, Jan M. ; Kuiper, Michael A. ; Bosch, Frank H. ; Zandstra, Durk F. ; Toornvliet, Arnoud C. ; Biemond, Hazra S. ; Kors, Bas M. ; Koelman, Johannes H. T. M. ; Verbeek, Marcel M. ; Weinstein, Henry C. ; Hijdra, Albert ; Horn, Janneke. / Prognosis of coma after therapeutic hypothermia: A prospective cohort study. In: Annals of neurology. 2012 ; Vol. 71, No. 2. pp. 206-212.

BibTeX

@article{df298a09bc424b319411a2c81cac40f4,
title = "Prognosis of coma after therapeutic hypothermia: A prospective cohort study",
abstract = "Objective: This study was designed to establish the reliability of neurologic examination, neuron-specific enolase (NSE), and median nerve somatosensory-evoked potentials (SEPs) to predict poor outcome in patients treated with mild hypothermia after cardiopulmonary resuscitation (CPR). Methods: This multicenter prospective cohort study included adult comatose patients admitted to the intensive care unit (ICU) after CPR and treated with hypothermia (32-34 C). False-positive rates (FPRs 1 specificity) with their 95% confidence intervals (CIs) were calculated for pupillary light responses, corneal reflexes, and motor scores 72 hours after CPR; NSE levels at admission, 12 hours after reaching target temperature, and 36 hours and 48 hours after collapse; and SEPs during hypothermia and after rewarming. The primary outcome was poor outcome, defined as death, vegetative state, or severe disability (Glasgow Outcome Scale 1-3) after 6 months. Results: Of 391 patients included, 53% had a poor outcome. Absent pupillary light responses (FPR 1; 95% CI, 0-7) or absent corneal reflexes (FPR 4; 95% CI, 1-13) 72 hours after CPR, and absent SEPs during hypothermia (FPR 3; 95% CI, 1-7) and after rewarming (FPR 0; 95% CI, 0-18) were reliable predictors. Motor scores 72 hours after CPR (FPR 10; 95% CI, 6-16) and NSE levels were not. Interpretation: In patients with persisting coma after CPR and therapeutic hypothermia, use of motor score or NSE, as recommended in current guidelines, could possibly lead to inappropriate withdrawal of treatment. Poor outcomes can reliably be predicted by testing brainstem reflexes 72 hours after CPR and performing SEP",
author = "Aline Bouwes and Binnekade, {Jan M.} and Kuiper, {Michael A.} and Bosch, {Frank H.} and Zandstra, {Durk F.} and Toornvliet, {Arnoud C.} and Biemond, {Hazra S.} and Kors, {Bas M.} and Koelman, {Johannes H. T. M.} and Verbeek, {Marcel M.} and Weinstein, {Henry C.} and Albert Hijdra and Janneke Horn",
year = "2012",
doi = "10.1002/ana.22632",
language = "English",
volume = "71",
pages = "206--212",
journal = "Annals of neurology",
issn = "0364-5134",
publisher = "John Wiley and Sons Inc.",
number = "2",

}

RIS

TY - JOUR

T1 - Prognosis of coma after therapeutic hypothermia: A prospective cohort study

AU - Bouwes, Aline

AU - Binnekade, Jan M.

AU - Kuiper, Michael A.

AU - Bosch, Frank H.

AU - Zandstra, Durk F.

AU - Toornvliet, Arnoud C.

AU - Biemond, Hazra S.

AU - Kors, Bas M.

AU - Koelman, Johannes H. T. M.

AU - Verbeek, Marcel M.

AU - Weinstein, Henry C.

AU - Hijdra, Albert

AU - Horn, Janneke

PY - 2012

Y1 - 2012

N2 - Objective: This study was designed to establish the reliability of neurologic examination, neuron-specific enolase (NSE), and median nerve somatosensory-evoked potentials (SEPs) to predict poor outcome in patients treated with mild hypothermia after cardiopulmonary resuscitation (CPR). Methods: This multicenter prospective cohort study included adult comatose patients admitted to the intensive care unit (ICU) after CPR and treated with hypothermia (32-34 C). False-positive rates (FPRs 1 specificity) with their 95% confidence intervals (CIs) were calculated for pupillary light responses, corneal reflexes, and motor scores 72 hours after CPR; NSE levels at admission, 12 hours after reaching target temperature, and 36 hours and 48 hours after collapse; and SEPs during hypothermia and after rewarming. The primary outcome was poor outcome, defined as death, vegetative state, or severe disability (Glasgow Outcome Scale 1-3) after 6 months. Results: Of 391 patients included, 53% had a poor outcome. Absent pupillary light responses (FPR 1; 95% CI, 0-7) or absent corneal reflexes (FPR 4; 95% CI, 1-13) 72 hours after CPR, and absent SEPs during hypothermia (FPR 3; 95% CI, 1-7) and after rewarming (FPR 0; 95% CI, 0-18) were reliable predictors. Motor scores 72 hours after CPR (FPR 10; 95% CI, 6-16) and NSE levels were not. Interpretation: In patients with persisting coma after CPR and therapeutic hypothermia, use of motor score or NSE, as recommended in current guidelines, could possibly lead to inappropriate withdrawal of treatment. Poor outcomes can reliably be predicted by testing brainstem reflexes 72 hours after CPR and performing SEP

AB - Objective: This study was designed to establish the reliability of neurologic examination, neuron-specific enolase (NSE), and median nerve somatosensory-evoked potentials (SEPs) to predict poor outcome in patients treated with mild hypothermia after cardiopulmonary resuscitation (CPR). Methods: This multicenter prospective cohort study included adult comatose patients admitted to the intensive care unit (ICU) after CPR and treated with hypothermia (32-34 C). False-positive rates (FPRs 1 specificity) with their 95% confidence intervals (CIs) were calculated for pupillary light responses, corneal reflexes, and motor scores 72 hours after CPR; NSE levels at admission, 12 hours after reaching target temperature, and 36 hours and 48 hours after collapse; and SEPs during hypothermia and after rewarming. The primary outcome was poor outcome, defined as death, vegetative state, or severe disability (Glasgow Outcome Scale 1-3) after 6 months. Results: Of 391 patients included, 53% had a poor outcome. Absent pupillary light responses (FPR 1; 95% CI, 0-7) or absent corneal reflexes (FPR 4; 95% CI, 1-13) 72 hours after CPR, and absent SEPs during hypothermia (FPR 3; 95% CI, 1-7) and after rewarming (FPR 0; 95% CI, 0-18) were reliable predictors. Motor scores 72 hours after CPR (FPR 10; 95% CI, 6-16) and NSE levels were not. Interpretation: In patients with persisting coma after CPR and therapeutic hypothermia, use of motor score or NSE, as recommended in current guidelines, could possibly lead to inappropriate withdrawal of treatment. Poor outcomes can reliably be predicted by testing brainstem reflexes 72 hours after CPR and performing SEP

U2 - 10.1002/ana.22632

DO - 10.1002/ana.22632

M3 - Article

C2 - 22367993

VL - 71

SP - 206

EP - 212

JO - Annals of neurology

JF - Annals of neurology

SN - 0364-5134

IS - 2

ER -

ID: 1601881