Bernard Cathala

Exploration du métabolisme énergétique cérébral et évolution des comas postanoxiques

An open prospective study of brain energy metabolism was carried out in 20 consecutive cases of coma occurring after cardiopulmonary arrest (CPA) of various causes. Mean age was 54 years and mean duration of CPA 2.75 min, with a mean of 11 min for resuscitation. Brain energy metabolism was compared with clinical course, electroencephalogram (EEG), and neurological outcome. All the patients were given the usual intensive care: intermittent positive pressure ventilation, haemodynamic control, sedation with benzodiazepines, neuromuscular paralysis, anticonvulsants, mannitol. A clinical examination and an EEG were carried out daily, 4 h after all drugs which might interfere with these investigations or brain energy metabolism had been stopped (except for anticonvulsants). Successive measurements of the cerebral arteriovenous oxygen (C (a - v) O2) and glucose (C (a - v)gluc) contents were made. The oxygen glucose index (OGI) was calculated according to Cohens formula. The first set of measurements were carried out within the first 30 h after CPA. The last measurements were made a few hours before death or recovery, or stabilization of the coma. Patients were assigned to 2 groups according to their neurological outcome: group R (n = 8), patients who recovered consciousness; group D (n = 12), patients who developed brain death or a vegetative state - Safars cerebral performance category 4. During the first 30 h, there was no relationship between clinical course, EEG and cerebral outcome. Half of the patients died or recovered within 72 h.(ABSTRACT TRUNCATED AT 250 WORDS)