Email updates

Keep up to date with the latest news and content from Critical Care and BioMed Central.

This article is part of the supplement: 33rd International Symposium on Intensive Care and Emergency Medicine

Poster presentation

Motor scores, therapeutic hypothermia and neurological outcome after cardiac arrest

M Davidson

  • Correspondence: M Davidson

Author Affiliations

Plymouth Hospitals NHS Trust, Plymouth, UK

Critical Care 2013, 17(Suppl 2):P317  doi:10.1186/cc12255


The electronic version of this article is the complete one and can be found online at: http://ccforum.com/content/17/S2/P317


Published:19 March 2013

© 2013 Davidson et al.; licensee BioMed Central Ltd.

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Introduction

Accurate prediction of neurological outcome after cardiac arrest is desirable to prevent inappropriate withdrawal of life-sustaining therapy in patients who could have a good neurological outcome, and to limit active treatment in patients whose ultimate neurological outcomes are poor. Established guidelines to predict neurological outcome after cardiac arrest were developed before the widespread use of therapeutic hypothermia. The American Association of Neurology guidelines [1] currently recommend that absent or extensor motor scores on day 3 post arrest are reliable indicators or poor neurological outcome with a false positive rate of 0 to 3%.

Methods

A review of existing literature was undertaken to examine whether the utility of motor scores to predict poor neurological outcome is influenced by the use of therapeutic hypothermia.

Results

Six studies were identified [2-7] that investigated the use of motor scores on day 3 post cardiac arrest in patients who had received therapeutic hypothermia. False positive rates (defined as 1 - specificity) for predicting poor neurological outcome were calculable in five of the six studies [2-6] and were 14%, 24%, 11%, 25% and 12% respectively. In all studies the FPR for motor scores of extension or worse were significantly higher than the 0% (0 to 3% 95% CIs) in the AAN guidelines.

Conclusion

Motor scores at day 3 post cardiac arrest of extension or worse do not reliably predict poor neurological outcome when therapeutic hypothermia has been used. Clinical neurological findings may not be valid predictors of poor neurological outcome after therapeutic hypothermia.

References

  1. Wijdicks , et al.:

    Neurology. 2006, 67:203-210. PubMed Abstract | Publisher Full Text OpenURL

  2. Thenayan Al, et al.:

    Neurology. 2008, 71:1535-1537. PubMed Abstract | Publisher Full Text OpenURL

  3. Rossetti , et al.:

    Ann Neurol. 2010, 67:301-307. PubMed Abstract | Publisher Full Text OpenURL

  4. Bisschops , et al.:

    Resuscitation. 2011, 82:696-701. PubMed Abstract | Publisher Full Text OpenURL

  5. Cronberg , et al.:

    Neurology. 2011, 77:623-630. PubMed Abstract | Publisher Full Text OpenURL

  6. Samaniego , et al.:

    Neurocrit Care. 2011, 15:113-119. PubMed Abstract | Publisher Full Text | PubMed Central Full Text OpenURL

  7. Fugate , et al.:

    Ann Neurol. 2010, 68:907-914. PubMed Abstract | Publisher Full Text OpenURL