Skip to main content
Log in

Prognostic significance of early intracranial and cerebral perfusion pressures in post-cardiac arrest anoxic coma

  • Originals
  • Published:
Intensive Care Medicine Aims and scope Submit manuscript

Abstract

The prognosis of prolonged cardiac arrests is generally related to brain damage due to the cerebral anoxia. A neurological worsening leading to irreversibility is sometimes associated with an increase in intracranial pressure. We studied for 5 years the early intracranial and cerebral perfusion pressures in 84 patients with deep anoxic coma after cardiac arrest. Intracranial pressure monitoring was set up as soon as possible with an extradural screw over a period of 6 days. No complications occured using this technique. We recorded the percentage of patients suffering from intracranial pressure peaks over 15 mmHg (a), over 25 mmHg (b) or cerebral perfusion pressures drops under 50 mmHg (c). We obtained during the 1 st day of monitoring: (a) 46.4%, (b) 21.4%, (c) 39%; during the 2nd day: (a) 73.6%, (b) 26.3%, (c) 55.9%. Eight patients (9.5%) were still alive after a couple of months, 4 of whom had no neurological sequelae; among the 76 non-survivors 63 (82.9%) had died because of cerebral anoxic damage. A daily comparison between survivors and non-survivors points out that the survivors' intracranial pressures were always lower than in the nonsurvivors and the survivors' cerebral perfusion pressures higher than in the non-survivors. Moreover, none of the patients showing intracranial peak pressures over 25 mmHg survived without after-effects. It is clear that many patients suffer early periods of high intracranial pressures and low cerebral perfusion pressures leading to a bad neurological prognosis. Intracranial pressure monitoring may allow assessment of patients' neurological status and prognosis after cardiac resuscitation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Cobb LA, Alvarez H, Copass MK (1976) A rapid response system for out-of-hospital cardiac emergencies. Med Clin North Am 60:283–285

    Google Scholar 

  2. Earnest MP, Yarnell PR, Merrill SL, Knapp GL (1980) Long-term survival and neurologic status after resuscitation from out-of-hospital cardiac arrest. Neurology 30:1298–1302

    Google Scholar 

  3. Gueugniaud PY, Vaudelin Th, Gaussorgues Ph, Petit P (1989) Out-of-hospital cardiac arrest: the teaching of experience at the SAMU of Lyon. Resuscitation 17:[Suppl] 79–98

    Google Scholar 

  4. Eisenberg S, Hallstrom A, Bergner L (1982) Long term survival after out-of-hospital cardiac arrest. N Engl J Med 306:1340–1343

    Google Scholar 

  5. Longstreth WT, Thomas SI, Cobb LA, Diehr P, Inui TS (1989) Neurologic recovery after out-of-hospital cardiac arrest. Ann Intern Med 98:588–592

    Google Scholar 

  6. Levy DE, Bates D, Caronna JJ, Cartilidge NE, Knill-Jones RP, Lapinski RH, Singer BH, Shaw DA, Plum F (1981) Prognosis in non traumatic coma. Ann Intern Med 94:293–301

    Google Scholar 

  7. Cole SL, Carday E (1956) Four-minute limit for cardiac resuscitation. JAMA 161:1454–1458

    Google Scholar 

  8. Neely WA, Youmans JR (1963) Anoxia of canine brain without damage. JAMA 183:1085–1087

    Google Scholar 

  9. Safar P, Stezoski W, Nemoto EM (1976) Amelioration of brain damage after 12 minutes cardiac arrest in dogs. Arch Neurol 33:91–95

    Google Scholar 

  10. Gueugniaud PY, Petit P (1986) Barbiturate therapy of prolonged circulatory arrest. Crit Care Med 14:259–260

    Google Scholar 

  11. Hossmann KA, Kleihues P (1973) Reversibility of ischemic brain damage. Arch Neurol 29:375–384

    Google Scholar 

  12. Safar P (1986) Cerebral resuscitation after cardiac arrest. Circulation 74:138–153

    Google Scholar 

  13. Dean JM, Mac Comb JF (1981) Intracranial pressure monitoring in severe pediatric near drowning. Neurosurgery 9:627–630

    Google Scholar 

  14. Huault F, Checoury A, Devictor D, Fries F, Mouzard A (1980) La mesure de la pression intracranienne dans les oedèmes cérébraux. Rev Pédiatr 16:555–568

    Google Scholar 

  15. Gaussorgues Ph, Guerin C, Boyer F, Holzapfel L, Mercatello A, Gerard M, Gueugniaud PY, Robert D (1987) Hypertension intracranienne et pression de perfusion cérébrale au cours des comas non traumatiques de l'adulte. Réanim Soins Intensifs Med Urg 3:191–194

    Google Scholar 

  16. Lamer Ch, Fraisse D, Ruttiman M, Mahiou P, Richter F, Raggueneau JL, Payen D, Pasteyer J (1989) Possibilités des inhibiteurs calciques dans le traitement de l'encéphalopathie post-arrêt circulatoire. Aggressologie 7:451–454

    Google Scholar 

  17. Schmidt A, Binner L, Mayer U, Stauch M (1988) The role of intracranial pressure (ICP) monitoring after cardiopulmonary resuscitation (CPR). Crit Care Med 16:389 (Abstract)

    Google Scholar 

  18. Longstreth WT, Diehr P, Inui TS (1983) Prediction of awakening after out-of-hospital cardiac arrest. N Engl J Med 308:1378–1382

    Google Scholar 

  19. Brown CG, Wermann HA, Davis EA, Hobson J, Hamlin RL (1987) The effects of graded doses of epinephrine on regional myocardial blood flow during cardiopulmonary resuscitation in swine. Circulation 75:491–497

    Google Scholar 

  20. Gueugniaud PY, Theurey O, Vaudelin T, Choux C, Prost G, Petit P (1990) Approche clinique de l'efficacité de l'adrénaline à fortes doses dans l'arrêt circulatoire. JEUR 4:255–260

    Google Scholar 

  21. Goetting MG, Paradis NA (1989) High dose epinephrine in refractory pediatric cardiac arrest. Crit Care Med 17:1258–1262

    Google Scholar 

  22. Weil MH, Ruiz CE, Michaels S, Rackow EC (1985) Acide base determinants of survival after cardiopulmonary resuscitation. Crit Care Med 13:888–892

    Google Scholar 

  23. Gueugniaud PY, Gaussorgues Ph, Rochette M, Bertin-Maghit M, Bertin-Maghit A, Vaudelin T, Robert D, Petit P (1988) Déséquilibres acido-basiques et métaboliques des arrêts circulatoires. Réanim Soins Intensifs Med Urg 4:300–305

    Google Scholar 

  24. Delooz HH, Lewi PJ, the Cerebral Resuscitation Study Group (1989) Are inter-center differences in EMS-management and sodium-bicarbonate administration important for the outcome of CPR? Resuscitation 17:[Suppl] 161–172

    Google Scholar 

  25. Gueugniaud PY, Gaussorgues Ph, Robert D, Gibault JP, Petit P (1987) Rôle de l'anoxie après arrêt cardiaque dans le métabolisme du glucose: incidence pratique. Presse Méd 16:1656

    Google Scholar 

  26. Calle PA, Buylaert WA, Vanhaute AD, Cerebral Resuscitation Study group (1989) Glycemia in the post-resuscitation period. Resuscitation 17:[Suppl] 181–188

    Google Scholar 

  27. Ames A III, Wright RL, Kowada M, Thurston JM, Majno G (1968) Cerebral ischemia II: the no-reflow phenomenon. Am J Pathol 52:437–453

    Google Scholar 

  28. White BC, Wiegenstein JG, Winegar CD (1984) Brain ischemic anoxia. Mechanisms of injury. JAMA 251:1586–1590

    Google Scholar 

  29. Lamer C, Raggueneau JL, Fraisse D, Payen D, Echter E (1989) Cerebral circulation and neuronal injury after cardiac arrest. JEUR 2:33–42

    Google Scholar 

  30. De Rougemont J, Barge M, Benabid A (1971) Un nouveau capteur pour la mesure de la PIC. Valeur de la dure-mère en tant que membrane susceptible de transmettre les pressions. Neurochirurgie 17:579–590

    Google Scholar 

  31. Siesjo BK (1981) Cell damage in the brain: an speculative synthesis. J Cereb Blood Flow Metab 1:155–185

    Google Scholar 

  32. Gueugniaud PY, Guaussorgues Ph, Mercatello A, Guerin C, Gerard M, Petit P, Robert D (1986) Etude prospective des variations précoces de la pression intracranienne: pronostic et traitement de 35 malades. In. Les comas. Expansion Scientifique Française, Paris, pp 161–163

    Google Scholar 

  33. Brain Resuscitation Clinical Trial I Study Group (1986) Randomized clinical study of thiopental loading in comatose survivors of cardiac arrest. N Engl J Med 314:397–403

    Google Scholar 

  34. White BC, Winegar CD, Wilson RF, Hoehner PJ, Trombley JH (1983) Possible role of calcium blockers in cerebral resuscitation for future studies. Crit Care Med 11:202–206

    Google Scholar 

  35. Roine RO, Kaste M, Kinnunen A, Nikki P, Sarna S, Kajaste S (1990) Nimodipine after resuscitation from out-of-hospital ventricular fibrillation. JAMA 264:3171–3177

    Google Scholar 

  36. Brain Resuscitation Clinical Trial II Study Group (1991) A randomized clinical study of a calcium-entry blocker (lidoflazine) in the treatment of comatose survivors of cardiac arrest. N Engl J Med 324:1225–1231

    Google Scholar 

  37. Gueugniaud PY, Guaussorgues Ph, garcia-Darennes F, Bancalari G, Roux H, Robert D, Petit P (1990) Early effects of nimodipine on intracranial and cerebral perfusion pressures in cerebral anoxia after out-of-hospital cardiac arrest. Resuscitation 20:203–212

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gueugniaud, P.Y., Garcia-Darennes, F., Gaussorgues, P. et al. Prognostic significance of early intracranial and cerebral perfusion pressures in post-cardiac arrest anoxic coma. Intensive Care Med 17, 392–398 (1991). https://doi.org/10.1007/BF01720676

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01720676

Key words

Navigation