Coma anóxico-isquémico en 46 pacientes: Evolución a treinta días y su relación con los reflejos de tronco / The absence of brainstem reflexes does not predict short term mortality in anoxic ischemic coma

ABSTRACT

Background: Anoxic-ischemic coma has a poor outcome with a high rate of mortality and morbidity. Therefore, clinical predictors of prognosis are needed for therapeutic decision-making. Patients and methods: Prospective analysis of 46 patients, 31 male, age range 19-85 years, with anoxic-ischemic coma following cardiac arrest. All the patients included in our study remained comatose with a Glasgow Coma Scale (GCS) score of six or less points, after their stabilization in the Intensive Care Unit. They were evaluated clinically using the pupillary light reflex, corneal reflex and vestibulo-ocular reflex testing, induced by caloric stimulation with cold water. Survival was evaluated using life tables. All patients were followed until the thirtieth day after the anoxic-ischemic event. Results: Thirty five patients (76%) died within the next twenty-nine days, 8 patients (18%) reached the vegetative state, 2 patients (4%) achieved a recovery with disability, and only 1 patient (2%) was discharged without sequelae. One day, five and 30 days survival rates were 89, 53 and 29%, respectively. The abolition of all brainstem reflexes was not a predictor of mortality. Conclusion: Thirty day survival in this group of patients was 29% and the absence of brainstem reflexes was not a predictor of mortality.