Neurological prognostication in comatose survivors of cardiac arrest requires a multimodal approach combining clinical and diagnostic tests. Most patients with good outcomes recover consciousness within 72–120 h of arrest, and therefore the suggested timing for prognostication is 72 h from ROSC, or later. Results of earlier prognostic tests, such as status myoclonus and NSE levels, should also be considered at this time point. A careful clinical neurological examination is the cornerstone of prognostic assessment [and it should be performed after major confounders, (e.g. residual sedation,neuromuscular blockade, metabolic derangements) have been excluded.Although absent or extensormotor responses to pain are not specific for predicting a poor neurological outcome, they are highly sensitive for identifying those patients who require neurological prognostication.
- Cardiac arrest