| 1. |
- Cronberg, Tobias, et al.
(författare)
-
A structured approach to neurologic prognostication in clinical cardiac arrest trials
- 2013
-
Ingår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. - : Springer Science and Business Media LLC. - 1757-7241. ; 21
-
Forskningsöversikt (refereegranskat)abstract
- Brain injury is the dominant cause of death for cardiac arrest patients who are admitted to an intensive care unit, and the majority of patients die after withdrawal of life sustaining therapy (WLST) based on a presumed poor neurologic outcome. Mild induced hypothermia was found to decrease the reliability of several methods for neurological prognostication. Algorithms for prediction of outcome, that were developed before the introduction of mild hypothermia after cardiac arrest, may have affected the results of studies with hypothermia-treated patients. In previous trials on neuroprotection after cardiac arrest, including the pivotal hypothermia trials, the methods for prognostication and the reasons for WLST were not reported and may have had an effect on outcome. In the Target Temperature Management trial, in which 950 cardiac arrest patients have been randomized to treatment at 33 degrees C or 36 degrees C, neuroprognostication and WLST-decisions are strictly protocolized and registered. Prognostication is delayed to at least 72 hours after the end of the intervention period, thus a minimum of 4.5 days after the cardiac arrest, and is based on multiple parameters to account for the possible effects of hypothermia.
|
|
| 2. |
- Cronberg, Tobias, et al.
(författare)
-
Brain injury after cardiac arrest : from prognostication of comatose patients to rehabilitation
- 2020
-
Ingår i: The Lancet Neurology. - 1474-4422. ; 19:7, s. 611-622
-
Forskningsöversikt (refereegranskat)abstract
- 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.
|
|
| 3. |
- Cronberg, Tobias
(författare)
-
Neuroprognostication of Cardiac Arrest Patients : Outcomes of Importance
- 2017
-
Ingår i: Seminars in Respiratory and Critical Care Medicine. - : Georg Thieme Verlag KG. - 1069-3424 .- 1098-9048. ; 38:6, s. 775-784
-
Forskningsöversikt (refereegranskat)abstract
- During the last two decades, survival rates after cardiac arrest have increased while the fraction of patients surviving with a severe neurological disability or vegetative state has decreased in many countries. While improved survival is due to improvements in the whole chain of survival, improved methods for prognostication of neurological outcome may be of major importance for the lower disability rates. Patients who are resuscitated and treated in intensive care will die mainly from the withdrawal of life-sustaining (WLST) therapy due to presumed poor chances of meaningful neurological recovery. To ensure high-quality decision-making and to reduce the risk of premature withdrawal of care, implementation of local protocols is crucial and should be guided by international recommendations. Despite rigorous neurological prognostication, cognitive impairment and related psychological distress and reduced participation in society will still be relevant concerns for cardiac arrest survivors. The commonly used outcome measures are not designed to provide information on these domains. Follow-up of the cardiac arrest survivor needs to consider the cardiovascular burden as an important factor to prevent cognitive difficulties and future decline.
|
|
| 4. |
|
|
| 5. |
|
|
| 6. |
- Cronberg, Tobias
(författare)
-
Should Postanoxic Status Epilepticus Be Treated Agressively? Yes!
- 2015
-
Ingår i: Journal of Clinical Neurophysiology. - 1537-1603. ; 32:6, s. 449-451
-
Forskningsöversikt (refereegranskat)abstract
- Cardiac arrest is common and has a high mortality rate. For resuscitated patients, the development of hypoxic-ischemic brain injury is the major culprit. Withdrawal of life-sustaining therapy is the cause of death for majority of patients with presumed severe brain injury, and assessment of prognosis should be evidence based and multimodal. Postanoxic status epilepticus is not an established criterion of a poor neurologic prognosis, and a good outcome is possible. Patients with postanoxic status epilepticus should therefore be actively treated with prolonged intensive care including antiepileptic and sedative agents to suppress seizure activity, if reliable indicators of a poor prognosis are absent.
|
|
| 7. |
- Cronberg, Tobias, et al.
(författare)
-
Withdrawal of life-sustaining therapy after cardiac arrest
- 2017
-
Ingår i: Seminars in Neurology. - : Georg Thieme Verlag KG. - 0271-8235 .- 1098-9021. ; 37:1, s. 81-87
-
Forskningsöversikt (refereegranskat)abstract
- An increasing number of patients are successfully resuscitated from cardiac arrest (CA) and subsequently treated in an intensive care unit due to unconsciousness. Approximately half of these patients will die during the first weeks postarrest, typically after a determination of a poor neurologic prognosis and a decision to withdraw life-sustaining therapy (WLST). These decisions are guided by universal ethical principles. Neurologic prognostication, WLST, and functional outcome after CA are closely correlated, but routines vary between and within countries. Recent studies indicate that premature decisions to withdraw care may be common. This topical review will focus on the decision of WLST for patients remaining unconscious after CA, the guiding ethical principles, and the interaction with neurologic prognostication and outcome.
|
|
| 8. |
- Friberg, Hans, et al.
(författare)
-
Clinical review: Continuous and simplified electroencephalography to monitor brain recovery after cardiac arrest.
- 2013
-
Ingår i: Critical Care. - : Springer Science and Business Media LLC. - 1364-8535. ; 17:4
-
Forskningsöversikt (refereegranskat)abstract
- There has been a dramatic change in hospital care of cardiac arrest survivors in recent years, including the use of target temperature management (hypothermia). Clinical signs of recovery or deterioration, which previously could be observed, are now concealed by sedation, analgesia, and muscle paralysis. Seizures are common after cardiac arrest, but few centers can offer high-quality electroencephalography (EEG) monitoring around the clock. This is due primarily to its complexity and lack of resources but also to uncertainty regarding the clinical value of monitoring EEG and of treating post-ischemic electrographic seizures. Thanks to technical advances in recent years, EEG monitoring has become more available. Large amounts of EEG data can be linked within a hospital or between neighboring hospitals for expert opinion. Continuous EEG (cEEG) monitoring provides dynamic information and can be used to assess the evolution of EEG patterns and to detect seizures. cEEG can be made more simple by reducing the number of electrodes and by adding trend analysis to the original EEG curves. In our version of simplified cEEG, we combine a reduced montage, displaying two channels of the original EEG, with amplitude-integrated EEG trend curves (aEEG). This is a convenient method to monitor cerebral function in comatose patients after cardiac arrest but has yet to be validated against the gold standard, a multichannel cEEG. We recently proposed a simplified system for interpreting EEG rhythms after cardiac arrest, defining four major EEG patterns. In this topical review, we will discuss cEEG to monitor brain function after cardiac arrest in general and how a simplified cEEG, with a reduced number of electrodes and trend analysis, may facilitate and improve care.
|
|
| 9. |
- Friberg, Hans, et al.
(författare)
-
Internationell och nationell konsensus om bästa vård efter hävt hjärtstopp. Många patienter blir helt återställda.
- 2010
-
Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518. ; 107:8, s. 2-514
-
Forskningsöversikt (refereegranskat)abstract
- An international consensus report on postresuscitation care after cardiac arrest has recently been published. Its content and main messages are in line with the recommendations from The Swedish Resuscitation Council, which include: diagnosing and treating the underlying disease, offering good general intensive care, considering hypothermia treatment, standardising prognostication and follow-up.
|
|
| 10. |
- Horn, Janneke, et al.
(författare)
-
Prognostication after cardiac arrest.
- 2014
-
Ingår i: Current Opinion in Critical Care. - 1531-7072. ; 20:3, s. 280-286
-
Forskningsöversikt (refereegranskat)abstract
- The prognosis of patients with postanoxic coma (PAC) after cardiac arrest is a challenging task for clinicians. The need for early and accurate prognostic predictors is crucial. Treatment with therapeutic hypothermia and sedation alters the reliability of neurological examination. Considering the extensive literature existing on this topic, we aimed to provide a practical approach on how to predict outcome in patients with PAC, particularly in those treated with therapeutic hypothermia.
|
|
