Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society
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J Clin Neurophysiol · Sep 2000
ReviewThe role of evoked potentials in anoxic-ischemic coma and severe brain trauma.
The early recognition of comatose patients with a hopeless prognosis-regardless of how aggressively they are managed-is of utmost importance. Median somatosensory evoked potentials supplement and enhance neurologic examination findings in anoxic-ischemic coma and severe brain trauma, and are useful as an early guide to outcome. The key finding is that bilateral absence of cortical evoked potentials, generated by thalamocortical tracts, reliably predicts unfavorable outcome in comatose patients after cardiac arrest, and correlates strongly with death or persistent vegetative state in severe brain trauma. ⋯ The majority of patients with normal central conduction times had a good outcome, whereas a delay in central conduction times increased the likelihood of neurologic deficit or death. This report includes a systematic review of the literature concerning adults in anoxic-ischemic coma and severe brain trauma, in which somatosensory evoked potentials were used as an early guide to predict clinical outcome. Greater use of somatosensory evoked potentials in anoxic-ischemic coma and severe brain trauma would identify those patients unlikely to recover and would avoid costly medical care that is to no avail.
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J Clin Neurophysiol · Sep 2000
Ethics in the intensive care unit with emphasis on medical futility in comatose survivors of cardiac arrest.
Medical futility refers to situations or cases in which treatment offers no meaningful benefit to the patient. Brain death does not pose a management problem because patients are considered to be dead. Management of other cases requires sequential considerations. ⋯ Then, if it is determined that there is no possibility of the patient regaining conscious awareness, a level of care should be decided through discussions involving the physician and significant others. Usually there is a consensus that high-level intensive care is not justified to maintain such a low quality of life. When the patient's advance directives or the substitute decision maker's request differs from the physician's recommendations, there are methods of resolving the issues that respect ethical and legal principles.