Neurological prognostication of outcome in patients in coma after cardiac arrest

Abstract

Management of coma after cardiac arrest has improved during the past decade, allowing an increasing proportion of patients to survive, thus prognostication has become an integral part of post-resuscitation care. Neurologists are increasingly confronted with raised expectations of next of kin and the necessity to provide early predictions of long-term prognosis. During the past decade, as technology and clinical evidence have evolved, post-cardiac arrest prognostication has moved towards a multimodal paradigm combining clinical examination with additional methods, consisting of electrophysiology, blood biomarkers, and brain imaging, to optimise prognostic accuracy. Prognostication should never be based on a single indicator; although some variables have very low false positive rates for poor outcome, multimodal assessment provides resassurance about the reliability of a prognostic estimate by offering concordant evidence.

Serum tau and neurological outcome in cardiac arrest

“…High specificity (low FPR) may be the most critical metric for use in cardiac arrest 3. We determined cutoffs for FPR = 0–5% (Table 2 and Fig 2B–D).…”

“…The length of ICU stay is increasing, but rates of mortality and neurological morbidity due to anoxic brain injury remain very high 2. There is a need for early and accurate prognostication methods, both to avoid prolonged treatment of patients where continued life‐supporting measures is futile, and to ensure that patients with potential for recovery receive optimal management 3. Possible prognostication methods include neurological examination, electroencephalography (EEG), short‐latency somatosensory evoked potentials (SSEPs), neuroimaging, biochemical markers, and automated pupillometry 4.…”

The interrelation between clinical presentation and neurophysiology of posthypoxic myoclonus

“…In case severity of PHM is the factor that predicts outcome, the UMRS might be a suitable tool to use 16, 27. It may be possible to add the aforementioned factors into a multi‐model algorithm that results in one prognostic score for PAE 12, 38. An example of this is the recently introduced Cerebral Recovery Index 39…”

Combination of Initial Neurologic Examination, Quantitative Brain Imaging and Electroencephalography to Predict Outcome After Cardiac Arrest

“…Some authors propose a stepwise approach to avoid premature WLST. 33 Recent published guidelines also highlighted a multimodal strategy to minimize erroneous prognostication [21][22] . The European Resuscitation Council and European Society of Intensive Care Medicine suggested using a prognostication algorithm in all comatose patients with an absent or extensor motor response to pain at ≥72 h from ROSC 21 .…”