Prognostic significance of early clinical manifestations in postanoxic coma: a retrospective study of 58 patients resuscitated after prehospital cardiac arrest.

The neurologic progress for 58 patients resuscitated after prehospital cardiac arrest was analyzed in order to evaluate their prognostic significance. Twenty-four patients were conscious on admission; their inhospital mortality rate was 4%. Thirty-four patients showed alterations of their state of consciousness; their inhospital mortality rate was 53%. On admission, only the absence of spontaneous breathing was significantly predictive of an unfavorable outcome. The failure of response to painful stimulation and pupillary light reflex became significantly predictive of an unfavorable outcome only in the late inhospital course. The time delay before onset of CPR was significantly longer in unconscious patients, but in this group no difference was observed between survivors and nonsurvivors. At discharge, no patient was in a comatose or vegetative state; three patients showed severe neurologic impairment. These data indicate that, in patients with postanoxic coma, early clinical evidence of severe neurologic dysfunction is predictive of neither inhospital death nor neurologic sequelae.