Out of hospital cardiac arrest (OHCA) is a major healthcare chal-13 lenge. In 2020, in England, the ambulance service attended 93,920 14 calls for OHCA, with just 8.3% of patients conveyed to hospital sur-15 viving to discharge. 1 Many patients suffer poor outcomes due to 16 hypoxic-ischaemic brain injury occurring prior to admission. 2 The 17 International Liaison Committee on Resuscitation (ILCOR) suggests 18 a multi-modality approach to neurological prognostication, including 19 clinical examination, neurophysiology, biomarkers and neuro-imag-20 ing to be performed no earlier than 72 hours when targeted temper-21 ature management and sedation have been safely discontinued. 3 22 However, utilization is poor; one study from Denmark suggests that 23 just 32% of OHCA patients underwent an electroencephalogram 24 (EEG) and 14% somatosensory evoked potential test (SSEP). 4 25 The Essex Cardiothoracic Centre, in the South East of the United 26 Kingdom delivers cardiac care to a population of 1.7 million people. 27 Typically, we see over 100 OHCA admissions per annum. One of the 28 many challenges has been how to deliver guideline directed neuro-29 prognostication in a stand-alone cardiac centre, whilst not having 30 access to the diagnostics and specialist staff essential for neurolog-31 ical-prognostication available to centres that exist within larger 32 hospitals. 33We have a unique nurse lead approach that ensures our patients 34 receive cutting edge neurological prognostication. We have previ-35 ously shown the feasibility of setting up a neurophysiology service 36 in standalone cardiac centre 5 and we now employ a highly specialist 37 cardiac nurse specifically for this purpose. Following acute treat-38 ment, OHCA patients are admitted to intensive care or the coronary 39 care unit. Our OHCA nurse then takes a clinical history and docu-40 ments and a MIRACLE-2 score. 6 They are responsible for a detailed 41 neurological assessment, including quantitative pupillometry and 42 brainstem reflexes. In addition, the nurse ensures that blood is drawn 43 at 72 hours for Neuronal Specific Enolase (NSE) levels. For patients 44 remaining comatose at 72 hours the nurse performs an SSEP and 45 EEG as well as ensuring a CT head has been done. The clinical pic-46 ture, neuro-physiology tests, and CT imaging are live-screened via 47 tele-conferencing software to a neurologist with a special interest 48 in neurological-prognostication, based off site. The results are veri-49 fied and discussed in a twice weekly neuro-prognostication MDT with 50 attending cardiologist and ICU consultant. Early neurological-prog-51 nostication may signal: poor outcomes instigating a palliative strat-52 egy, indeterminate results requiring continued supportive therapies 5. Watson N, Damian M, Potter M, et al. Increasing cardiac arrest 91 survivor access to advanced neuromonitoring and 92 neuroprognostication, as recommended in international guidelines -A 93
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