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What are the recovery chances after a cardiac arrest?

DOCTOR OF THE MONTH - Nov 2013
Nov 2013
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A member of my family (70 year old femaie) suffered cardiac arrest. She had an EEG 1.5 weeks after attack and they are seeing bursts in her EEG. The neurologist rated her as vegetative with episodes of minimal consiousness based on this EEG at 1.5 weeks. She opened her eyes approximately 2 days post attack, has pupillary and pain reflex and just in the last few days appeared (2-2.5 weeks post arrest) to be able to move her index finger on command and mimics murmering sounds semingly on command. She seems to also have reflexive movements in her right arm and left leg. She opens her eyes alot but we do not think track things but does seem to turn her head to orient toward someone speaking to her. . She is medically stable (heart output is 79-80 % now) so we need to figure out where to send her next. She is about 2.5 weeks post arrest at this point. I know 1 month the vegetative state is referred to as persistant, 3 months as permanent. What would you recommend for further testing or how long to wait and see what progress she is likely to make. She would probably not want to live in a vegetative state for the rest of her life but would want a chance to see if she does make a decent functional recovery. Your thoughts? Is an EEG reading indicative of long term prognosis or a snapshot in time. Hence can one determine the long term expected state of consiousness based on an EEG at 1.5 weeks post cardiac arrest. It was continues monitoring for a number of days I should add keeping in mind we are seeing some small behavioral signs sinces that EEG. I know there are not absolutes but I would like to get the best statistics I can. Hence as you hear the behavioral descriptions above, what is probablity one might progress to next higher level (in what time frame if at all possible.) I would love a reference to any good articles online if you can, with statistics if available.Thank you.
Posted Thu, 13 Feb 2014 in Stroke
Follow-up: What are the recovery chances after a cardiac arrest? 18 minutes later
Is an EEG reading indicative of long term prognosis or a snapshot in time. Hence can one determine the long term expected state of consiousness based on an EEG at 1.5 weeks post cardiac arrest. It was continues monitoring for a number of days I should add keeping in mind we are seeing some small behavioral signs sinces that EEG. I know there are not absolutes but I would like to get the best statistics I can. Hence as you hear the behavioral descriptions above, what is probablity one might progress to next higher level (in what time frame if at all possible.) I would love a reference to any good articles online if you can, with statistics if available.
 
 
Answered by Dr. Sudhir Kumar 3 minutes later
Brief Answer: My reply is below. Detailed Answer: Hi, Thank you for posting your query. It is unfortunate that the person suffered cardiac arrest, resulting into hypoxic brain damage. The extent of damage to brain and the chances of recovery depend on the duration of cardiac arrest. In people with cardiac arrest lasting longer than five minutes, the chance of a meaningful recovery of brain functions is very less. Following tests can be done to assess the brain functions: 1. Bedside clinical neurological examination, 2. serial EEGs, 3. Evoked potential studies, 4. PET scsn of brain All the above tests can give us information regarding brain functions and recovery. I agree with the timelines regarding persistent and permanent vegetative states. The patient should be kept in a neuro-rehabilitation set up to maximise the chances of recovery. I hope it helps. Please get back if you have any follow up queries. Best wishes, Dr Sudhir Kumar MD DM (Neurology) XXXXXXX Consultant Neurologist Apollo Hospitals, Hyderabad
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Follow-up: What are the recovery chances after a cardiac arrest? 1 hour later
I sent the following question about an hour ago. I assume it has been received but wanted to make sure it had. Thank you. Is an EEG reading indicative of long term prognosis or a snapshot in time. Hence can one determine the long term expected state of consiousness based on an EEG at 1.5 weeks post cardiac arrest. It was continues monitoring for a number of days I should add keeping in mind we are seeing some small behavioral signs sinces that EEG. I know there are not absolutes but I would like to get the best statistics I can. Hence as you hear the behavioral descriptions above, what is probablity one might progress to next higher level (in what time frame if at all possible.) I would love a reference to any good articles online if you can, with statistics if available.
 
 
Answered by Dr. Sudhir Kumar 8 hours later
Brief Answer: Thank you for getting back. Detailed Answer: EEG not only indicates the state of brain activity at one point of time, but also is predictive of the future expected recovery of brain functions. Patterns such as alpha coma, alpha theta coma, burst suppression, isoelectric EEG are all indicative of poor likelihood of good functional recovery of brain functions. On the other hand, slow waves (such as XXXXXXX waves or theta waves) indicate a better chance of meaningful recovery of brain functions. I hope it helps. Best wishes, Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by
 
Follow-up: What are the recovery chances after a cardiac arrest? 12 hours later
Can you please refer me to any scholarly journals that would have research articles with empirical, statistical predictive analysis (with correlation coeeficients, regression coefficients) of the predictive power of each of the correlates of outcomes based on the EEG results. Also does time of the EEG make a difference? I have a statistical background so would like to see these kinds of articles to help with this decision making process. Thank you.
 
 
Answered by Dr. Sudhir Kumar 1 hour later
Brief Answer: My reply is below. Detailed Answer: You can refer this article below. Chen R, Bolton CF, Young B. Prediction of outcome in patients with anoxic coma: a clinical and electrophysiologic study. Crit Care Med. 1996 Apr;24(4):672-8. Timing of EEG does matter. Multiple EEGs done at different points of time are more valuable than a single EEG. Also, EEG findings should be correlated to clinical examination, somatosensory evoked potentials, etc to determine the prognosis of brain function recovery. Best wishes, Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by
 
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