The natural course of neurological recovery following cardiopulmonary resuscitation

Abstract

In 231 patients resuscitated from circulatory arrest of cardiovascular or pulmonary aetiology brain recovery was evaluated by serial neurological and EEG examinations for up to 1 year. One-hundred and sixteen patients never regained consciousness; 115 patients awakened within 30 days, and 40 eventually recovered completely within 90 days. Patients who had electrocortical activity recorded by the immediate post-resuscitation EEG ( N=106), and patients initially without such activity ( N=125) pursued the same course of recovery: during unconsciousness, interrelated EEG and neurological findings featured a phase of intermittent cortical activity with postural or stereotypic motor responses followed by a phase of continuous cortical activity with sequential appearances of delta, theta, and alpha activities on EEG accompanied by stereotypic or defensive motor responses. After awakening, the sequential return of motor, sensory, and mental faculties differentiated an early phase of severe disability with orientating eye movements and a bilateral Babinski response from the phase of moderate disability featured by speech, locomotor functions, ability to cope with personal necessities and orientation as to personal data, and a normal plantar response. Finally, orientation as to time, place and role of other persons, and retention and recall, defined the phase of slight/no disability. Abnormal courses were identified by incomplete EEG and neurological recoveries or by the appearance of spikes and sharpwaves in the EEG, or by losses of function.