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.
