New guidelines on coma outcome issued

Reported by Susan Aldridge, PhD, medical journalist

Some tests are better than others when it comes to predicting survival after a coma.
When someone is in a coma, family members are naturally anxious to know the likely outcome as this will influence decisions they have to make for the person. There are various tests a neurologist can carry out which will help him or her discuss the patient's condition with the family. The American Academy of Neurology has now issued some new guidelines that can help assess the patient in a coma following cardiopulmonary resuscitation (CPR).

The researchers looked at all the evidence in an attempt to find out how best to predict death, continued coma, or profound disability at six months. One good predictor of such poor coma outcome is absence of pupillary or corneal reflexes in the eye. This means the pupil does not contract if light is shone upon it. Nor does the eye blink if water is dripped on the cornea.

Another strong predictive test in coma is the absence of movement in response to pain. But issues around the CPR itself did not seem to be predictive of coma outcome. If the neurologist concentrates on the tests that are good predictors, then they will be able to comfort and support the family by giving them the best possible information on what may happen next.

Source
Neurology 26th July 2006

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