Brain injury after cardiac arrest: from prognostication of comatose patients to rehabilitation

被引:110
作者
Cronberg, Tobias [1 ]
Greer, Dowd M. [2 ]
Lilja, Gisela [1 ]
Moulaert, Veronique [3 ]
Swindell, Paul [4 ]
Rossetti, Andrea O. [5 ,6 ]
机构
[1] Lund Univ, Skane Univ Hosp, Neurol, Dept Clin Sci, S-22100 Lund, Sweden
[2] Boston Univ, Sch Med, Dept Neurol, Boston, MA 02118 USA
[3] Univ Groningen, Univ Med Ctr Groningen, Dept Rehabil Med, Groningen, Netherlands
[4] Sudden Cardiac Arrest UK, Surrey, Essex, England
[5] Univ Hosp Lausanne, Dept Clin Neurosci, Lausanne, Switzerland
[6] Univ Lausanne, Lausanne, Switzerland
关键词
NEURON-SPECIFIC ENOLASE; QUALITY-OF-LIFE; TARGETED TEMPERATURE MANAGEMENT; TERM NEUROLOGICAL OUTCOMES; FOCUSED FOLLOW-UP; SUSTAINING THERAPY; CARDIOPULMONARY-RESUSCITATION; MYOCARDIAL-INFARCTION; STATUS EPILEPTICUS; SURVIVORS;
D O I
10.1016/S1474-4422(20)30117-4
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
More patients are surviving cardiac arrest than ever before; however, the burden now lies with estimating neurological prognoses in a large number of patients who were initially comatose, in whom the ultimate outcome is unclear. Neurologists, neurointensivists, and clinical neurophysiologists must accurately balance the concern that overly conservative prognostication could leave patients in a severely disabled state, with the possibility that inaccurately pessimistic prognostication could lead to the withdrawal of life-sustaining treatment in patients who might otherwise have a good functional outcome. Prognostic tools have improved greatly, including electrophysiological tests, neuroimaging, and chemical biomarkers. Conclusions about the prognosis should be delayed at least 72 h after arrest to allow for the clearance of sedative drugs. Cognitive impairments, emotional problems, and fatigue are common among patients who have survived cardiac arrest, and often go unrecognised despite being related to caregiver burden and a decreased participation in society. Through simple screening, these problems can be identified, and patients can be provided with adequate information and rehabilitation.
引用
收藏
页码:611 / 622
页数:12
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