Wijdicks et al identified factors associated with a poor outcome for a patient who is comatose following resuscitation for a cardiopulmonary arrest. The authors are from the Quality Standards Committee of the American Academy of Neurology and are from multiple institutions in North America and Europe.


Patient selection: coma following cardiopulmonary resuscitation (CPR), without any major confounders:

(1) acute renal failure

(2) acute hepatic failure

(3) shock (cardiogenic, other)

(4) severe metabolic acidosis

(5) sedative therapy

(6) neuromuscular blocking agent therapy

(7) induced hypothermia


Poor outcomes include:

(1) death

(2) persisting unconsciousness at 1 month after resuscitation

(3) severe disability requiring full nursing care at 6 months after resuscitation


Indicators of brain death - absence of all of the following at the same time:

(1) pupil reflex

(2) corneal reflex

(3) cough reflex

(4) oculocephalic reflex


Indicators of a poor outcome - any of the following:

(1) myoclonus status epilepticus <= 24 hours after CPR

(2) absent N20 component of the somatosensory evoked potential (SSEP) anytime from day 1 to 3 after CPR

(3) serum neuron specific enolase (NSE) > 33 µg/L anytime from day 1 to 3 after CPR

(4) absent pupil or corneal reflex from 1 to 3 days after CPR

(5) extensor motor response or no motor response >= 72 hours after CPR


A patient who is not brain dead and not at risk for poor outcome will have an indeterminate outcome.


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