Multiple studies have examined motor-centric outcomes, with few studies examining quality of life (QoL) or cognition. Better functional outcomes have been suggested for lobar versus non-lobar ICH; few studies attempted finer topographic comparisons. This study highlights the need for improved reporting in ICH outcomes research, including a detailed description of hemorrhage location, reporting of the full range of functional outcome scales, and inclusion of cognitive and QoL outcomes.

Purpose-To assess the performance of neuroprognostic guidelines proposed by the American Academy of Neurology (AAN), European Resuscitation Council/European Society of Intensive Care Medicine (ERC/ESICM), and American Heart Association (AHA) in predicting outcomes of patients who remain unconscious after cardiac arrest. Methods-We retrospectively identified a cohort of unconscious post-cardiac arrest patients at a single tertiary care centre from 2011 to 2017 and reviewed hospital records for clinical, radiographic, electrophysiologic, and biochemical findings. Outcomes at discharge and 6 months post-arrest were abstracted and dichotomized as good (Cerebral Performance Category (CPC) scores of 1-2) versus poor (CPC 3-5). Outcomes predicted by current guidelines were compared to actual outcomes, with false positive rate (FPR) used as a measure of predictive value. Results-Of 226 patients, 36% survived to discharge, including 24 with good outcomes; 52% had withdrawal of life-sustaining therapies (WLST) during hospitalization. The AAN guideline yielded discharge and 6-month FPR of 8% and 15%, respectively. In contrast, the ERC/ESICM

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Objectives: End-of-life care and decisions on withdrawal of life-sustaining therapies vary across countries, which may affect the feasibility of future multicenter cardiac arrest trials. In Brazil, withdrawal of life-sustaining therapy is reportedly uncommon, allowing the natural history of postcardiac arrest hypoxic-ischemic brain injury to present itself. We aimed to characterize approaches to neuroprognostication of cardiac arrest survivors among physicians in Brazil. Design: Cross-sectional study. Setting: Between August 2, 2019, and July 31, 2020, we distributed a web-based survey to physicians practicing in Brazil. Subjects: Physicians practicing in Brazil and members of the Brazilian Association of Neurointensive Care, who care for patients resuscitated following cardiac arrest. Interventions: Not applicable. Measurements and Main Results: Responses from 185 physicians were obtained. Pupillary reflexes, corneal reflexes, and motor responses were considered critical to prognostication, whereas neuroimaging and electroencephalography were also regarded as important. For patients without targeted temperature management, absent pupillary and corneal reflexes at 24 hours postarrest were considered strongly predictive of poor neurologic outcome by 31.8% and 33.0%, respectively. For targeted temperature management-treated patients, absent pupillary and corneal reflexes at 24-hour postrewarming were considered prognostic by 22.9% and 20.0%, respectively. Physicians felt comfortable making definitive prognostic recommendations at day 6 postarrest or later (34.2%) for nontargeted temperature management-treated patients, and at day 6 postrewarming (20.4%) for targeted temperature management-treated patients. Over 90% believed that improving neuroprognostic accuracy would affect end-of-life decision-making. Conclusions: There is significant variability in neuroprognostic approaches to postcardiac arrest patients and timing of prognostic studies among Brazilian physicians, with practices frequently deviating from current guidelines, underscoring a need for greater neuroprognostic accuracy. Nearly all physicians believed that improving neuroprognostication will impact end-of-life decision-making. Given the tendency to delay prognostic recommendations while using similar neuroprognostic tools, Brazil offers a unique cohort in which to examine the natural history of hypoxic-ischemic brain injury in future studies.

Background: The modified Rankin Scale (mRS) and the Barthel Index (BI) are both commonly employed measures of recovery used in intracerebral hemorrhage (ICH) patients. While these measures have been utilized routinely between 3 to 6 months post-hemorrhage, few outcome studies have compared improvements in these measures in long-term outcome.out to one year. The aim of this study was to examine differences in improvement across these measures through up to 12 months post-ICH. Methods: 139 patients diagnosed with primary ICH at Yale-New Haven Hospital were prospectively enrolled in this observational study between July 1, 2014, and July 1, 2016. Patient recovery was evaluated using the mRS and BI at discharge, 3 months, 6 months, and 12 months. Repeated-measures parametric and non-parametric testing was conducted to examine improvement in measures over time. Results: Using the BI, there was a significant improvement across time points (p = 0.005), with follow-up testing showing improvement between discharge and 3 months (p < 0.001), 6 months (p < 0.001), and 12 months (p = 0.036), and between 3 months and 12 months (p = 0.021). There was no significant trend in mRS scores across all time points in non-parametric testing (p > 0.05). Between individual time points, there was a significant improvement in mRS scores between discharge and 3 months (p = 0.004) as well as 6 months (p = 0.010). Conclusions: These results suggest improved recovery of ICH patients in activities of daily living up to 1 year post-hemorrhage. While the mRS has a plateau effect in measuring recovery for this patient population between 3 and 6 months, the BI may be a more sensitive measure for assessing recovery up to 12 months.