Predicting the Outcome From Hypoxic-Ischemic Coma: Medical and Ethical Implications

In a recent issue ofThe Journal, Levy et al¹have presented a summary of their work on the outcome of coma in 210 patients with brain hypoxia or ischemia. This work is an extension of previous publications.²⁻⁴The statistics are somber: 57% of patients died without opening their eyes, 20% attained only the vegetative state, and only 13% recovered independent function. The authors believe that simple clinical data could have predicted the outcome in many of the 87% of patients who did not achieve independent function, data such as fixed pupils on the first day or absent or posturing motor responses after three days. The authors draw several conclusions about the care of comatose patients from these data. Two features of this article are of particular interest: the general applicability of its prognostic factors for predicting outcome from ischemic/hypoxic coma and the ethical implications of such predictions