Favorable Neurological Status Research Articles

Retrospective Analysis of 14 Cases of Spinal Epidural Hematoma

Objective: Spinal epidural hematoma (SEH) is rare diseases and they may have various causes. We reviewed our clinical experiences and analyzed the various factors related to the outcome for SEH. Methods: We investigated 14 patients (8 men and 6 women) who underwent hematoma removal for SEH from January 2003 to December 2010. We investigated age, gender, hypertension, anticoagulant use, radiographic finding such as the degree of cord compression and the extent and location of the hematoma and relationship between preoperative neurologic status, surgical timing and neurological outcome using the Japanese Orthopaedic Association (JOA) score by examining medical records. Results: In ten cases (71.4%) of operated 14 cases, there were post-operative improvements (recovery scale >50%) in clinical symptoms. We performed operation within 12 hour for seven cases, and the average of recovery scale for these cases was 69.9%. Six (85.7%) of these cases improved more than 50% on the recovery scale. There were seven cases that we performed operations on that were beyond 12 hour, and the average of the recovery scale was 47.7%. The average of the recovery scale in cases of incomplete injury after the operation was 64.4%, and the average of the recovery scale was 38.1% in cases of complete injury. There was a significant difference between two groups (p<0.05). Conclusion: Our present study demonstrates that surgical time interval and preoperative neurological status correlated with neurological recovery. The rapidity of surgical intervention and preoperative favorable neurological status maximize neurological recovery. (J Korean Neurotraumatol Soc 2011;7:51-56)

Predictors of resuscitation outcome in a swine model of VF cardiac arrest: A comparison of VF duration, presence of acute myocardial infarction and VF waveform

Introduction Factors that affect resuscitation to a perfusing rhythm (ROSC) following ventricular fibrillation (VF) include untreated VF duration, acute myocardial infarction (AMI), and possibly factors reflected in the VF waveform. We hypothesized that resuscitation of VF to ROSC within 3 min is predicted by the VF waveform, independent of untreated VF duration or presence of acute MI. Methods AMI was induced by the occlusion of the left anterior descending coronary artery. VF was induced in normal ( N = 30) and AMI swine ( N = 30). Animals were resuscitated after untreated VF of brief (2 min) or prolonged (8 min) duration. VF waveform was analyzed before the first shock to compute the amplitude-spectral area (AMSA) and slope. Results Unadjusted predictors of ROSC within 3 min included untreated VF duration (8 min vs 2 min; OR 0.11, 95%CI 0.02–0.54), AMI (AMI vs normal; OR 0.11, 95%CI 0.02–0.54), AMSA (highest to lowest tertile; OR 15.5, 95%CI 1.7–140), and slope (highest to lowest tertile; OR 12.7, 95%CI 1.4–114). On multivariate regression, untreated VF duration ( P = 0.011) and AMI ( P = 0.003) predicted ROSC within 3 min. Among secondary outcome variables, favorable neurological status at 24 h was only predicted by VF duration (OR 0.22, 95% CI 0.05–0.92). Conclusions In this swine model of VF, untreated VF duration and AMI were independent predictors of ROSC following VF cardiac arrest. AMSA and slope predicted ROSC when VF duration or the presence of AMI were unknown. Importantly, the initial treatment of choice for short duration VF is defibrillation regardless of VF waveform.

Preshock Cardiopulmonary Resuscitation Worsens Outcome From Circulatory Phase Ventricular Fibrillation With Acute Coronary Artery Obstruction in Swine

Some clinical studies have suggested that chest compressions before defibrillation improve survival in cardiac arrest because of prolonged ventricular fibrillation (VF; ie, within the circulatory phase). Animal data have also supported this conclusion, and we have previously demonstrated that preshock chest compressions increase the VF median frequency and improve the likelihood of a return of spontaneous circulation in normal swine. We hypothesized that chest compressions before defibrillation in a swine model of acute myocardial ischemia would also increase VF median frequency and improve resuscitation outcome. Twenty-six swine were subjected to balloon occlusion of the left anterior descending coronary artery for 2 hours. The balloon was removed and VF was induced and untreated for 8 minutes. Swine were then treated with up to 3 stacked defibrillation shocks (n=13, shock-first group) or 3 minutes of chest compressions before shock (n=13, preshock cardiopulmonary resuscitation group). In the preshock cardiopulmonary resuscitation group, median frequency was increased from 7.0+/-0.8 to 13.9+/-1.6 Hz after chest compressions (P=0.002). Despite the improved median frequency in the preshock cardiopulmonary resuscitation group, 24-hour survival with favorable neurological status was significantly worse in the preshock cardiopulmonary resuscitation group (1/13) compared with the shock-first group (8/13, P=0.01). In a swine model of prolonged VF in acute myocardial ischemia, 24-hour survival with favorable neurological status was more likely when defibrillation was performed first without preceding chest compressions. Myocardial substrate is an important factor in determining the optimal resuscitation strategy.

Evolution of tibial SSEP after traumatic spinal cord injury: Baseline for clinical trials

Objective To describe the spontaneous evolution of tibial somatosensory evoked potentials (tSSEPs) after spinal cord injury (SCI) and its relation to neurological and functional parameters. Methods tSSEPs were assessed in 297 patients within five standardized time intervals throughout the first year after injury, along with neurological and functional parameters. Results Roughly 60% of the patients did not show any recordable tSSEP throughout the first year after injury. Approximately 20% had recordable potentials at every assessment stage and showed an improvement of tSSEP parameters over time. In about 10% of the patients, a potential recovered during the first year. In the remaining cases, potentials were inconsistently recordable. All groups showed a similar amount of neurological and functional improvement. Conclusions Recordability, latencies and amplitudes of tSSEPs can change over time after SCI. The early recordability of a tSSEP is associated with a favorable functional and neurological status and outcome. In contrast, an initially absent tSSEP is not always associated with a poorer status and outcome but only in those 75% of the patients in whom the potential remains absent. Significance This exact description of the spontaneous improvements of neurophysiological, neurological and functional parameters after SCI is an important prerequisite in appraising the efficacy of new interventional therapies.