Year: 2001
Type: article
Abstract: To the Editor: We congratulate Valenzuela et al. and Page et al. (Oct.26 issue) on their studies of defibrillation in casinos 1 and airplanes.2 The advantage of immediate diagnosis and treatment is certain.However, the authors missed the opportunity to demonstrate sustained preservation of neurologic, neuropsychological, and behavioral brain function.Discharge from the hospital is a crude criterion for survival with a healthy brain.[1][2][3] The best function, according to another commonly used standard, the Glasgow Cerebral Performance Scale, includes "minor psychological or neurological defects (mild dysphasia, non-incapacitating hemiparesis, or minor cranial nerve abnormalities)."Memory testing is not specified.This level of function is not likely to be sufficient to allow one to resume running a business or pursuing a profession.In our review of studies of cardiopulmonary resuscitation (CPR) that provided even crude, varied measures of extended outcome, at least 50 percent of survivors had neuropsychological impairment and pathologic depression.3 A reluctance to acknowledge that neurologic injury occurs need not diminish enthusiasm for CPR.Most persons who undergo CPR out of the hospital do not provide informed consent in advance.We believe that follow-up assessments of both the benefits and the risks of out-of-hospital CPR should be made widely available.The value of reliable mental-function tests has been well demonstrated in studies of degenerative brain disease, obstructive sleep apnea, the acute respiratory distress syndrome, and coronary by-pass surgery.4,5 We have proposed that such evaluations be included in all new trials of CPR.
Source: New England Journal of Medicine
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2341893312