ERC-ESICM guidelines for prognostication after cardiac arrest: time for an update

About two-thirds of patients who are comatose after resuscitation from cardiac arrest die before hospital discharge, of whom two-thirds die from neurological injury. In these patients, prognostication is crucial in informing clinicians and patient’s relatives. Recently, three studies from different groups of investigators have retrospectively assessed the accuracy of the 2015 ERC-ESICM prognostication algorithm. All these studies consistently confirmed the accuracy of the ERC-ESICM multimodal prognostication strategy in avoiding a falsely pessimistic prediction. Interestingly, this high specificity was confirmed when the 2014 criteria for malignant EEG were replaced with a more recent classification of EEG pattern. Besides improving sensitivity of prediction, this classification also enables a good interrater reliability, favouring guidelines’ implementation.