Course of neurological recovery and cerebral prognostic signs during cardio-pulmonary resuscitation

Abstract 

The recovery of cranial nerve reflexes was evaluated sequentially in time during the efforts at resuscitation in 111 victims of circulatory arrest of primary cardiovascular or pulmonary origin. Fifty-seven patients had some brain function when life support was initiated (Group I) while 54 had at first no such function (Group II). Recovery occurred in a fixed order, irrespective of the initial neurological status or subsequent outcome: spontaneous respiratory movements were either present or were the first function to return; thereafter followed pupillary light reflexes, coughing-swallowing, and ciliospinal reflexes, in that order. Orderly recovery was featured by a time-related return of reflexes and consciousness while abnormal courses were characterized by stagnation of the recovery process, lack of time—related return of and loss of function. Prognostic rules were similar for the two population groups. Reflex tests at 10–60 min of resuscitation differentiated patients who would regain consciousness from those remaining unconscious with sensitivities and specificities ≥80. A positive pupillary response or coughing-swallowing at 10 min, or ciliospinal reflex at 20 min predicted return of consciousness with positive predictive values of 0.85–1.00 (prior odds 0.29) while negative tests at 20–30 min indicated failure of complete recovery with values of 0.94–100 (prior odds 0.89).

Keywords:  Cardiopulmonary arrest, Resuscitation, Cerebral ischemia, Brain stem, Neurologic examination, Patient outcome assessment