Neuroprognostication in the Post Cardiac Arrest Patient: A Canadian Cardiovascular Society Position Statement

Fordyce, Christopher B.; Kramer, Andreas H.; Ainsworth, Craig; Christenson, Jim; Hunter, Gary; Kromm, Julie; Soto, C; Scales, Damon C.; Sekhon, Mypinder S.; Diepen, Sean van; Dragoi, Laura; Josephson, Colin B.; Kutsogiannis, Jim; May, Michel R. Le; Overgaard, Christopher B.; Savard, Martin; Schnell, Gregory; Wong, Graham C.; Belley‐Côté, Emilie P.; Fantaneanu, Tadeu A.; Granger, Christopher B.; Luk, Adriana; Mathew, Rebecca; McCredie, Victoria; Murphy, Laurel; Teitelbaum, Jeanne

doi:10.1016/j.cjca.2022.12.014

Cited by 12 publications

(7 citation statements)

References 118 publications

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“…There is no gold standard approach to prognostication in hypoxic-ischemic brain injury, and the best diagnostic approaches leave many patients with an uncertain prognosis 88,89 . Guidelines developed by multiple societies (ie, European Resuscitation Council and European Society of Intensive Care Medicine, American Heart Association, and Neurocritical Care Society) exist to help clinicians prognosticate, 24,38,90,91 yet many clinicians do not follow them 92 . Guidelines outline the use of multimodal testing ( table 2-3 93 lists tests, and figure 2-6 shows European Resuscitation Council guidelines).…”

Section: Neuroprognosticationmentioning

confidence: 99%

Emergent Management of Hypoxic-Ischemic Brain Injury

Steinberg

2024

CONTINUUM: Lifelong Learning in Neurology

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OBJECTIVE This article outlines interventions used to improve outcomes for patients with hypoxic-ischemic brain injury after cardiac arrest. LATEST DEVELOPMENTS Emergent management of patients after cardiac arrest requires prevention and treatment of primary and secondary brain injury. Primary brain injury is minimized by excellent initial resuscitative efforts. Secondary brain injury prevention requires the detection and correction of many pathophysiologic processes that may develop in the hours to days after the initial arrest. Key physiologic parameters important to secondary brain injury prevention include optimization of mean arterial pressure, cerebral perfusion, oxygenation and ventilation, intracranial pressure, temperature, and cortical hyperexcitability. This article outlines recent data regarding the treatment and prevention of secondary brain injury. Different patients likely benefit from different treatment strategies, so an individualized approach to treatment and prevention of secondary brain injury is advisable. Clinicians must use multimodal sources of data to prognosticate outcomes after cardiac arrest while recognizing that all prognostic tools have shortcomings. ESSENTIAL POINTS Neurologists should be involved in the postarrest care of patients with hypoxic-ischemic brain injury to improve their outcomes. Postarrest care requires nuanced and patient-centered approaches to the prevention and treatment of primary and secondary brain injury and neuroprognostication.

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Section: Neuroprognosticationmentioning

confidence: 99%

Emergent Management of Hypoxic-Ischemic Brain Injury

Steinberg

2024

CONTINUUM: Lifelong Learning in Neurology

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“…Physicians are also skeptical about the possibility of basing the prognosis only on biomarker concentration values, and it is also necessary to perform electrophysiological tests and neuroimaging [120]. The need for an interdisciplinary approach in neuroprognostication has also also indicated in the Canadian Cardiovascular Society Position Statement, in which biomarkers are just one of many indicated aspects that should be taken into account when determining patient prognoses [121,122]. Other sources also point to the need for an interdisciplinary approach [123].…”

Section: Searching For New Biomarkers and Regulatory Approachesmentioning

confidence: 99%

Predictive Performance of Neuron-Specific Enolase (NSE) for Survival after Resuscitation from Cardiac Arrest: A Systematic Review and Meta-Analysis

Kurek,

Swieczkowski,

Pruc

et al. 2023

JCM

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The prediction of outcomes following cardiac arrest continues to provide significant difficulties. A preferred strategy involves adopting a multimodal approach, which encompasses the careful evaluation of the biomarker neuron-specific enolase (NSE). This systematic review and meta-analysis aimed to gather and summarize new and existing evidence on the prediction effect of neuron-specific enolase for survival to hospital discharge among adult patients with cardiac arrest. We searched PubMed Central, Scopus, EMBASE databases, and the Cochrane Library without language restrictions from their inceptions until 30 October 2023 and checked the reference lists of the included studies. Pooled results were reported as standardized mean differences (SMDs) and were presented with corresponding 95% confidence intervals (CIs). The primary outcome was survival to hospital discharge (SHD). Eighty-six articles with 10,845 participants were included. NSE showed a notable degree of specificity in its ability to predict mortality as well as neurological status among individuals who experienced cardiac arrest (p < 0.05). This study demonstrates the ability to predict fatality rates and neurological outcomes, both during the time of admission and at various time intervals after cardiac arrest. The use of NSE in a multimodal neuroprognostication algorithm has promise in improving the accuracy of prognoses for persons who have undergone cardiac arrest.

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“… 3 This time interval allows for recovery from ischemic-reperfusion injury, clearance of medication such as sedatives and paralytics, and recovery after targeted temperature management. 4 , 5 , 6 This uncertainty during the early post-cardiac arrest period makes discussions regarding goals of care and therapeutic planning difficult with patient families. Risk stratification of patients can help to reduce uncertainty during this period and inform discussions around patient care.…”

Section: Introductionmentioning

confidence: 99%

Predicting survival post-cardiac arrest: An observational cohort study

Drennan,

Thorpe,

Scales

et al. 2023

Resuscitation Plus

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Neuroprognostication in the Post Cardiac Arrest Patient: A Canadian Cardiovascular Society Position Statement

Cited by 12 publications

References 118 publications

Emergent Management of Hypoxic-Ischemic Brain Injury

Emergent Management of Hypoxic-Ischemic Brain Injury

Predictive Performance of Neuron-Specific Enolase (NSE) for Survival after Resuscitation from Cardiac Arrest: A Systematic Review and Meta-Analysis

Predicting survival post-cardiac arrest: An observational cohort study

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