TY - JOUR
T1 - Neurological prognostication after cardiac arrest
AU - Sandroni, Claudio
AU - Geocadin, Romergryko G.
PY - 2015
Y1 - 2015
N2 - Purpose of review
Prediction of neurological prognosis in patients who are comatose after successful resuscitation from
cardiac arrest remains difficult. Previous guidelines recommended ocular reflexes, somatosensory evoked
potentials and serum biomarkers for predicting poor outcome within 72 h from cardiac arrest. However,
these guidelines were based on patients not treated with targeted temperature management and did not
appropriately address important biases in literature.
Recent findings
Recent evidence reviews detected important limitations in prognostication studies, such as low precision
and, most importantly, lack of blinding, which may have caused a self-fulfilling prophecy and
overestimated the specificity of index tests. Maintenance of targeted temperature using sedatives and
muscle relaxants may interfere with clinical examination, making assessment of neurological status before
72 h or more after cardiac arrest unreliable.
Summary
No index predicts poor neurological outcome after cardiac arrest with absolute certainty. Prognostic
evaluation should start not earlier than 72 h after ROSC and only after major confounders have been
excluded so that reliable clinical examination can be made. Multimodality appears to be the most
reasonable approach for prognostication after cardiac arrest.
AB - Purpose of review
Prediction of neurological prognosis in patients who are comatose after successful resuscitation from
cardiac arrest remains difficult. Previous guidelines recommended ocular reflexes, somatosensory evoked
potentials and serum biomarkers for predicting poor outcome within 72 h from cardiac arrest. However,
these guidelines were based on patients not treated with targeted temperature management and did not
appropriately address important biases in literature.
Recent findings
Recent evidence reviews detected important limitations in prognostication studies, such as low precision
and, most importantly, lack of blinding, which may have caused a self-fulfilling prophecy and
overestimated the specificity of index tests. Maintenance of targeted temperature using sedatives and
muscle relaxants may interfere with clinical examination, making assessment of neurological status before
72 h or more after cardiac arrest unreliable.
Summary
No index predicts poor neurological outcome after cardiac arrest with absolute certainty. Prognostic
evaluation should start not earlier than 72 h after ROSC and only after major confounders have been
excluded so that reliable clinical examination can be made. Multimodality appears to be the most
reasonable approach for prognostication after cardiac arrest.
KW - Biomarkers
KW - Brain Diseases
KW - Coma
KW - Combined Modality Therapy
KW - Electroencephalography
KW - Evoked Potentials, Somatosensory
KW - Heart Arrest
KW - Humans
KW - Hypothermia, Induced
KW - Neurologic Examination
KW - Prognosis
KW - Biomarkers
KW - Brain Diseases
KW - Coma
KW - Combined Modality Therapy
KW - Electroencephalography
KW - Evoked Potentials, Somatosensory
KW - Heart Arrest
KW - Humans
KW - Hypothermia, Induced
KW - Neurologic Examination
KW - Prognosis
UR - http://hdl.handle.net/10807/72053
U2 - 10.1097/MCC.0000000000000202
DO - 10.1097/MCC.0000000000000202
M3 - Article
SN - 1070-5295
VL - 21
SP - 209
EP - 214
JO - Current Opinion in Critical Care
JF - Current Opinion in Critical Care
ER -