Download PDF
Aktuelle Neurologie 2012; 39(03): 145-154
DOI: 10.1055/s-0032-1308995
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Prognose der Hirnfunktion nach kardiopulmonaler Reanimation und therapeutischer Hypothermie

Prognosis for Brain Function Following Cardiopulmonary Resuscitation and Therapeutic Hypothermia
C. Leithner
1   Klinik für Neurologie, Campus Virchow Klinikum, Charité Universitätsmedizin Berlin
,
C Storm
2   Klinik für Nephrologie und internistische Intensivmedizin, Campus Virchow Klinikum, Charité Universitätsmedizin Berlin
,
D. Hasper
2   Klinik für Nephrologie und internistische Intensivmedizin, Campus Virchow Klinikum, Charité Universitätsmedizin Berlin
,
C. J. Ploner
1   Klinik für Neurologie, Campus Virchow Klinikum, Charité Universitätsmedizin Berlin
› Author Affiliations
Further Information

Publication History

Publication Date:
12 April 2012 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Die milde therapeutische Hypothermie hat als Standardbehandlung die Prognose von Patienten nach Herzstillstand und Reanimation deutlich verbessert. Eine zunehmende Anzahl von Studien aus den letzten Jahren zeigt, dass die Hypothermie-Behandlung aber auch Einfluss auf etablierte klinische und paraklinische Prognoseparameter nimmt, sodass eine Neubewertung notwendig geworden ist. Insbesondere die motorische Reaktion auf Schmerzreize und eine Serumkonzentration der neuronenspezifischen Enolase (NSE) von > 33 μg/l am Tag 3 nach Reanimation erlauben keine verlässliche Aussage mehr über ein mögliches Wiedererwachen. In der aktuellen Situation einer noch heterogenen Studienlage sollte die prognostische Einschätzung von mit Hypothermie behandelten Patienten nach Herzstillstand nur vorsichtig und in Gesamtschau mehrerer prognostischer Parameter erfolgen.

Abstract

Mild therapeutic hypothermia has become a standard treatment and has markedly improved the prognosis of patients after cardiac arrest and resuscitation. An increasing number of recent studies has shown that therapeutic hypothermia influences the prognostic value of clinical, laboratory and electrophysiological parameters in these patients. Hence, a re-evaluation of these parameters appears necessary. Specifically, motor response to painful stimuli and a serum concentration of neuron specific enolase (NSE) of >33 μg/l tested on day 3 after resuscitation do no longer allow for valid prognosis of the possibility of re-awakening. Facing the heterogeneous results from recent studies, prognosis in patients treated with hypothermia after cardiac arrest should always be based on careful interpretation of several prognostic parameters.

Schlüsselwörter

Herzstillstand - Hypothermie - Prognose - Reanimation - hypoxische Enzephalopathie

Keywords

cardiac arrest - hypothermia - prognosis - resuscitation - hypoxic encephalopathy
 

  • Literatur

  • 1 Trappe HJ. Prä- oder intrahospitaler Herz-Kreislaufstillstand. Häufigkeit, Ergebnisse, Perspektiven. Der Kardiologe 2009; 3: 37-46
    CrossrefPubMedGoogle Scholar
  • 2 Bernard SA, Gray TW, Buist MD et al. Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med 2002; 346: 557-563
    CrossrefPubMedGoogle Scholar
  • 3 Hypothermia after Cardiac Arrest Study Group . Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Eng J Med. 2002. 346. 549-556 Erratum in: N Engl J Med 2002; 346: 1756
    Google Scholar
  • 4 van der Wal G, Brinkman S, Bisschops LL et al. Influence of mild therapeutic hypothermia after cardiac arrest on hospital mortality. Crit Care Med 2011; 39: 84-88
    CrossrefPubMedGoogle Scholar
  • 5 Storm C, Nee J, Krüger A et al. 2-year survival of patients undergoing mild hypothermia treatment after ventricular fibrillation cardiac arrest is significantly improved compared to historical controls. Scand J Trauma Resusc Emerg Med 2010; 8: 2-
    PubMedGoogle Scholar
  • 6 Polderman KH. Mechanisms of action, physiological effects, and complications of hypothermia. Crit Care Med 2009; 37: S186-S202
    CrossrefPubMedGoogle Scholar
  • 7 Storm C, Nee J, Roser M et al. Mild hypothermia treatment in patients resuscitated from non-shockable cardiac arrest. Emerg Med J 2012; 29: 100-103
    CrossrefPubMedGoogle Scholar
  • 8 Dumas F, Grimaldi D, Zuber B et al. Is hypothermia after cardiac arrest effective in both shockable and nonshockable patients?: insights from a large registry. Circulation 2011; 123: 877-886
    CrossrefPubMedGoogle Scholar
  • 9 Kim YM, Yim HW, Jeong SH et al. Does therapeutic hypothermia benefit adult cardiac arrest patients presenting with non-shockable initial rhythms?: A systematic review and meta-analysis of randomized and non-randomized studies. Resuscitation 2012; 83: 188-196
    CrossrefPubMedGoogle Scholar
  • 10 Lundbye JB, Rai M, Ramu B et al. Therapeutic hypothermia is associated with improved neurological outcome and survival in cardiac arrest survivors of non-shockable rhythmus. Resuscitation 2012; 83: 202-207
    CrossrefPubMedGoogle Scholar
  • 11 Testori C, Sterz F, Behringer W et al. Mild therapeutic hypothermia is associated with favourable outcome in patients after cardiac arrest with non-shockable rhythms. Resuscitation 2011; 82: 1162-1167
    CrossrefPubMedGoogle Scholar
  • 12 Lippert FK, Raffay V, Georgiou M et al. European Resuscitation Council Guidelines for Resuscitation 2010 Section 10. The ethics of resuscitation and end-of-life decisions. Resuscitation 2010; 81: 1445-1451
    CrossrefPubMedGoogle Scholar
  • 13 Wijdicks EF, Hijdra A, Young GB et al. Practice parameter: prediction of outcome in comatose survivors after cardiopulmonary resuscitation (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology Neurology 2006; 67: 203-210
    CrossrefPubMed
  • 14 Aguila A, Funderburk M, Guler A et al. Clinical predictors of survival in patients treated with therapeutic hypothermia following cardiac arrest. Resuscitation 2010; 81: 1621-1626
    CrossrefPubMedGoogle Scholar
  • 15 Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet 1974; 13: 81-84
    PubMedGoogle Scholar
  • 16 Barolat-Romana G, Larson SJ. Influence of stimulus location and limb position on motor responses in the comatose patient. J Neurosurg 1984; 61: 725-728
    CrossrefPubMedGoogle Scholar
  • 17 Wijdicks EF, Bamlet WR, Maramattom BV et al. Validation of a new coma scale: The FOUR score. Ann Neurol 2005; 58: 585-593
    CrossrefPubMedGoogle Scholar
  • 18 Rittenberger JC, Sangl J, Wheeler M et al. Association between clinical examination and outcome after cardiac arrest. Resuscitation 2010; 81: 1128-1132
    CrossrefPubMedGoogle Scholar
  • 19 Al Thenayan E, Savard M, Sharpe M et al. Predictors of poor neurologic outcome after induced mild hypothermia following cardiac arrest. Neurology 2008; 71: 1535-1537
    CrossrefPubMedGoogle Scholar
  • 20 Bisschops LL, van Alfen N, Bons S et al. Predictors of poor neurologic outcome in patients after cardiac arrest treated with hypothermia: a retrospective study. Resuscitation 2011; 82: 696-701
    CrossrefPubMedGoogle Scholar
  • 21 Rossetti AO, Oddo M, Logroscino G et al. Prognostication after cardiac arrest and hypothermia: a prospective study. Ann Neurol 2010; 67: 301-307
    PubMedGoogle Scholar
  • 22 Samaniego EA, Mlynash M, Caulfield AF et al. Sedation confounds outcome prediction in cardiac arrest survivors treated with hypothermia. Neurocrit Care 2011; 15: 113-119
    CrossrefPubMedGoogle Scholar
  • 23 Fukuoka N, Aibiki M, Tsukamoto T et al. Biphasic concentration change during continuous midazolam administration in brain-injured patients undergoing therapeutic moderate hypothermia. Resuscitation 2004; 60: 225-230
    CrossrefPubMedGoogle Scholar
  • 24 Cronberg T, Rundgren M, Westhall E et al. Neuron-specific enolase correlates with other prognostic markers after cardiac arrest. Neurology 2011; 77: 623-630
    CrossrefPubMedGoogle Scholar
  • 25 Born JD, Hans P, Albert A et al. Interobserver agreement in assessment of motor response and brain stem reflexes. Neurosurgery 1987; 20: 513-517
    CrossrefPubMedGoogle Scholar
  • 26 Daubin C, Quentin C, Allouche S et al. Serum neuron-specific enolase as predictor of outcome in comatose cardiac arrest survivors: a prospective cohort study. BMC Cardiovasc Disord 2011; 11: 48
    CrossrefPubMedGoogle Scholar
  • 27 Fugate JE, Wijdicks EF, Mandrekar J et al. Predictors of neurologic outcome in hypothermia after cardiac arrest. Ann Neurol 2010; 68: 907-914
    CrossrefPubMedGoogle Scholar
  • 28 Bouwes A, Binnekade JM, Kuiper MA et al. Prognosis and prognostication after cardiacarrest and hypothermia; results of PROPACII, a Dutch multicenter, prospective cohort study. Intensive Care Med. 2010 36. S297
    PubMedGoogle Scholar
  • 29 Lance JW, Adams RD. The syndrome of intention or action myoclonus as a sequel to hypoxic encephalopathy. Brain 1963; 86: 111-136
    CrossrefPubMedGoogle Scholar
  • 30 Young GB, Gilbert JJ, Zochodne DW. The significance of myoclonic status epilepticus in postanoxic coma. Neurology 1990; 40: 1843-1848
    CrossrefPubMedGoogle Scholar
  • 31 Wijdicks EF, Parisi JE, Sharbrough FW. Prognostic value of myoclonus status in comatose survivors of cardiac arrest. Ann Neurol 1994; 35: 239-243
    CrossrefPubMedGoogle Scholar
  • 32 English WA, Giffin NJ, Nolan JP. Myoclonus after cardiac arrest: pitfalls in diagnosis and prognosis. Anaesthesia 2009; 64: 908-911
    CrossrefPubMedGoogle Scholar
  • 33 Rossetti AO, Oddo M, Liaudet L et al. Predictors of awakening from postanoxic status epilepticus after therapeutic hypothermia. Neurology 2009; 72: 744-749
    CrossrefPubMedGoogle Scholar
  • 34 Lucas JM, Cocchi MN, Salciccioli J et al. Neurologic recovery after therapeutic hypothermia in patients with post-cardiac arrest myoclonus. Resuscitation 2012; 83: 265-269
    CrossrefPubMedGoogle Scholar
  • 35 Bouwes A, Binnekade JM, Verbaan BW et al. Predictive value of neurological examination for early cortical responses to somatosensory evoked potentials in patients with postanoxic coma. J Neurol 2012; 259: 537-541
    CrossrefPubMedGoogle Scholar
  • 36 Koht A, Schutz W, Schmidt G et al. Effects of etomidate, midazolam, and thiopental on median nerve somatosensory evoked potentials and the additive effect of fentanyl and nitrous oxide. Anesth Analg 1988; 67: 435-441
    PubMedGoogle Scholar
  • 37 Leithner C, Ploner CJ, Hasper D et al. Does hypothermia influence the predictive value of bilateral absent N20 after cardiac arrest?. Neurology 2010; 23: 965-969
    PubMedGoogle Scholar
  • 38 Synek VM. Validity of a revised EEG coma scale for predicting survivial in anoxic encephalopathy. Clin Exp Neurol 1989; 26: 119-127
    PubMedGoogle Scholar
  • 39 Rossetti AO, Logroscino G, Liaudet L et al. Status epilepticus: an independent outcome predictor after cerebral anoxia. Neurology 2007; 69: 255-260
    CrossrefPubMedGoogle Scholar
  • 40 Kaplan PW, Morales Y. Re: Status epilepticus: an independent outcome predictor after cerebral anoxia. Neurology. 2008; 70: 1295 author reply 1295–1296
    PubMedGoogle Scholar
  • 41 Thömke F, Brand A, Weilemann SL. The temporal dynamics of postanoxic burst-suppression EEG. J Clin Neurophysiol 2002; 19: 24-31
    CrossrefPubMedGoogle Scholar
  • 42 Rundgren M, Westhall E, Cronberg T et al. Continuous amplitude-integrated electroencephalogram predicts outcome in hypothermia-treated cardiac arrest patients. Crit Care Med 2010; 38: 1838-1844
    CrossrefPubMedGoogle Scholar
  • 43 Thenayan EA, Savard M, Sharpe MD et al. Electroencephalogram for prognosis after cardiac arrest. J Crit Care 2010; 25: 300-304
    CrossrefPubMedGoogle Scholar
  • 44 Rossetti AO, Urbano LA, Delodder F et al. Prognostic value of continuous EEG monitoring during therapeutic hypothermia after cardiac arrest. Crit Care 2010; 14: R173
    CrossrefPubMedGoogle Scholar
  • 45 Ramont L, Thoannes H, Volondat A et al. Effects of hemolysis and storage condition on neuron-specific enolase (NSE) in cerebrospinal fluid and serum: Implications in clinical practice. Clin Chem Lab Med 2005; 43: 1215-1217
    CrossrefPubMedGoogle Scholar
  • 46 Pfeifer R, Börner A, Krack A et al. Outcome after cardiac arrest: predictive values an limitations of the neuroproteins neuron-specific enolase and protein S-100 and the Glasgow Coma Scale. Resuscitation 2005; 65: 49-55
    CrossrefPubMedGoogle Scholar
  • 47 Steffen IG, Hasper D, Ploner CJ et al. Mild therapeutic hypothermia alters neuron specific enolase as an outcome predictor after resuscitation: 97 prospective hypothermia patients compared to 133 historical non-hypothermia patients. Crit Care 2010; 14: R69
    CrossrefPubMedGoogle Scholar
  • 48 Reisinger J, Höllinger K, Lang W et al. Prediction of neurological outcome after cardiopulmonary resuscitation by serial determination of serum neuron-specific enolase. Eur Heart J 2007; 28: 52-58
    PubMedGoogle Scholar
  • 49 Tortorici MA, Kochanek PM, Poloyac SM. Effects of hypothermia on drug disposition, metabolism, and response: A focus of hypothermia-mediated alterations on the cytochrome P450 enzyme system. Crit Care Med 2007; 35: 2196-2204
    CrossrefPubMedGoogle Scholar
  • 50 Mörtberg E, Zetterberg H, Nordmark J et al. S-100B is superior to NSE, BDNF and GFAP in predicting outcome of resuscitation from cardiac arrest with hypothermia treatment. Resuscitation 2011; 82: 26-31
    CrossrefPubMedGoogle Scholar
  • 51 Shinozaki K, Oda S, Sadahiro T et al. Serum S-100B is superior to neuron-specific enoloase as an early prognostic biomarker for neurological outcome following cardiopulmonary resuscitation. Resuscitation 2009; 80: 870-875
    CrossrefPubMedGoogle Scholar
  • 52 Inamasu J, Miyatake S, Tomioka H et al. Subarachnoid hemorrhage as a cause of out-of-hospital cardiac arrest: a prospective computed tomography study. Resuscitation 2009; 80: 977-980
    CrossrefPubMedGoogle Scholar
  • 53 Kürkciyan I, Meron G, Sterz F et al. Spontaneous subarachnoid hemorrhage as a cause of out-of-hospital cardiac arrest. Resuscitation 2001; 51: 27-32
    CrossrefPubMedGoogle Scholar
  • 54 Yuzawa H, Higano S, Mugikura S et al. Pseudo-subarachnoid hemorrhage found in patients with postresuscitation encephalopathy: characteristics of CT findings and clinical importance. AJNR Am J Neuroradiol 2008; 29: 1544-1549
    CrossrefPubMedGoogle Scholar
  • 55 Metter RB, Rittenberger JC, Guyette FX et al. Association between a quantitative CT scan measure of brain edema and outcome after cardiac arrest. Resuscitation 2011; 82: 1180-1185
    CrossrefPubMedGoogle Scholar
  • 56 Choi SP, Park HK, Park KN et al. The density ratio of grey to white matter on computed tomography as an early predictor of vegetative state or death after cardiac arrest. Emerg Med J 2008; 25: 666-669
    CrossrefPubMedGoogle Scholar
  • 57 Järnum H, Knutsson L, Rundgren M et al. Diffusion and perfusion MRI of the brain in comatose patients treated with mild hypothermia after cardiac arrest: a prospective observational study. Resuscitation 2009; 80: 425-430
    CrossrefPubMedGoogle Scholar
  • 58 Mlynash M, Campbell DM, Leproust EM et al. Temporal and spatial profile of brain diffusion-weighted MRI after cardiac arrest. Stroke 2010; 41: 1665-1672
    CrossrefPubMedGoogle Scholar
  • 59 Wu O, Sorensen AG, Benner T et al. Comatose patients with cardiac arrest: predicting clinical outcome with diffusion-weighted MR imaging. Radiology 2009; 252: 173-181
    CrossrefPubMedGoogle Scholar
  • 60 Wijman CA, Mlynash M, Caulfield AF et al. Prognostic value of brain diffu­sion-weighted imaging after cardiac arrest. Ann Neurol 2009; 65: 394-402
    CrossrefPubMedGoogle Scholar