ATS Reading List

Neurology Critical Care

Coma/Anoxic Brain Injury

Levy DE, Caronna JJ, Singer BH, et al. Predicting outcome from hypoxic-ischemic coma. JAMA 1985;253:1420-6. The relevance of the prognostic predictors determined by physical examination in this landmark study may be less certain in the era of therapeutic hypothermia.
PMID: 3968772

Wijdicks EF, Hijdra A, Young GB, et al. Practice parameter: prediction of outcome in comatose survivors after cardiopulmonary resuscitation (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2006; 67:203-10. Excellent, practical review from the AAN.
PMID: 16864809
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Coplin WM, Pierson DJ, Cooley KD, et al. Implications of extubation delay in brain-injured patients meeting standard weaning criteria. Am J Respir Crit Care Med 2000;161:1530-6. Prospective cohort study found patients with "delayed" extubation had increased incidence of nosocomial pneumonia, longer ICU and hospital stays, and greater hospital charges.
PMID: 10806150
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Therapeutic hypothermia following cardiac arrest

The following simultaneously-published studies found reducing core body temperature to 32°C to 34°C for 12 or 24 hours improved neurologic outcomes in comatose survivors of out-of-hospital cardiac arrest with an initial shockable rhythm:

Bernard SA, Gray TW, Buist MD, et al. Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med 2002; 346:557-63.
PMID: 11856794
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The Hypothermia After Cardiac Arrest Study Group. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med 2002; 346:549-56.
PMID: 11856793
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Nielsen N, Wettersley J, Cronberg T, et al. Targeted temperature management at 33°C versus 36°C after cardiac arrest. N Engl J Med. 2013;369:2197-206. This larger RCT of 950 patients with out-of-hospital cardiac arrest found that patients who survived an out of hospital cardiac arrest but remained unconscious had similar outcomes whether temperature was targeted for 33oC or 36oC.
PMID: 24237006
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Jabre P, Bougouin W, Dumas F, et al. Early identification of patients with out-of-hospital cardiac arrest with no chance of survival and consideration for organ donation. Ann Intern Med. 2016; 165:770-8. The benefits of therapeutic hypothermia were demonstrated in patients presenting with a shockable rhythm, but aggressive resuscitation and cooling are recommended for patients with out-of-hospital cardiac arrest (OHCA) regardless of presenting rhythm. This retrospective analysis of a French registry from 2011 to 2014 found no survivors to hospital discharge among 772 patients who met all of the following 3 criteria: 1) OHCA not witnessed by medics, 2) non-shockable initial cardiac rhythm, and 3) no ROSC prior to receipt of a 3rd 1-mg dose of epinephrine. Validation in an additional 2,000 patients who met these criteria from other registries and trials found 1 survivor, in a persistent vegetative state.
PMID: 27618681

Acute stroke

Morgenstern LB, Hemphill JC 3rd, Anderson C, et al. Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2010; 41:2108-29. Guidelines offer primarily expert-opinion based recommendations and acknowledge the lack of available evidence to guide medical management. Published prior to more recent studies showing recombinant factor VII does not improve clinical outcomes.
PMID: 20651276
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Jauch EC, Saver JL, Adams HP Jr, et al. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/ American Stroke Association. Recent guideline for the management of acute ischemic stroke. Stroke 2013; 44:870-947.
PMID: 23370205
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Powers WJ, Derdeyn CP, Biller J, et al. 2015 American Heart Association/American Stroke Association Focused Update of the 2013 Guidelines For The Early Management Of Patients With Acute Ischemic Stroke Regarding Endovascular Treatment: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2015; 46:3020-3035. This focused update highlights recent evidence on endovascular treatment. Emergent non-enhanced CT imaging is affirmed, but if endovascular therapy is contemplated, a noninvasive intracranial vascular study is strongly recommended during initial imaging if it will not delay intravenous r-tPA. It also recommends that patients eligible for intravenous r-tPA receive it even if endovascular treatments are being considered.  Endovascular interventions that may benefit patients in the 4.5 to 6 hour window are also addressed.
PMID: 26123479
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Qureshi A, Palesch Y, Barsan W, et al. Intensive blood-pressure lowering in patients with acute cerebral hemorrhage. N Engl J Med. 2016;375:1033-43. A randomized open label trial of aggressive (110-139 mmHg) versus standard (140-179 mmHg) BP management of patients with spontaneous supratentorial cerebral hemorrhage within 4.5 hours of onset. This is a response to the INTERACT2 trial, which initiated treatment within 6 hours of onset. The mean SBP at 2 hours was 128 mm Hg in the aggressive group and 141 mmHg in the standard group. There were no differences in death or disability at 3 months, and the rate of renal adverse events within 7 days of randomization were higher in the aggressive control group.
PMID: 27276234
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ICU-acquired weakness

Griffiths RD and Hall JB. Intensive care unit-acquired weakness. Crit Care Med 2010;38:779-87. An updated review of ICU-acquired weakness that offers concise summaries of risk factors, pathophysiology, and prevention, including early mobilization.
PMID: 20048676

***See also Ventilation and Weaning


DeGans J, van de Beek D. Dexamethasone in adults with bacterial meningitis. N Engl J Med 2002; 347:1549-56. High quality RCT including 301 patients found early administration of 10 mg dexamethasone q 6 hrs for 4 days reduced the risk of poor outcome (score of 5 vs. score of 1-4 on Glasgow Outcome Scale) [relative risk 0.59] and was associated with a relative risk of death of 0.48. Subgroup analysis showed that the outcome improvement was restricted to patients with pneumococcal meningitis.
PMID: 12432041
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Last Reviewed: June 2017