Neurological outcomes after cardiac arrest: cold and dark issues - Critical Care Science (CCS)
Prognostication after cardiac arrest is important for patients, families and health providers. It also has ethical and social implications. With the introduction of therapeutic hypothermia after recovery from cardiac arrest in comatose patients,(,) prognostication has become more complex and concerns have been raised, particularly about the amount of time and the number of tools required for this treatment.
The 2010 guidelines() emphasized the lack of high-level studies that support the use of any imaging modality to predict the outcomes of comatose cardiac arrest survivors and supported the view that decisions to limit care should not be made based on the results of a single prognostication tool. Since then, some progress has been made. The 2015 guidelines highlight the need for a careful, daily, clinical neurological examination as the foundation for prognostication and reference the existence of multiple studies that support the use of multiple testing modalities that might be categorized as follows: clinical examination; neurophysiological studies – somatosensory evoked potentials and electroencephalography; biochemical markers – neuron-specific enolase as the most commonly used; imaging studies – brain computed tomography and magnetic resonance imaging (MRI).()
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Prognostication after cardiac arrest is important for patients, families and health providers. It also has ethical and social implications. With the introduction of therapeutic hypothermia after recovery from cardiac arrest in comatose patients,(,) prognostication has become more complex and concerns have been raised, particularly about the amount of time and the number of tools required for this treatment.
The 2010 guidelines() emphasized the lack of high-level studies that support the use of any imaging modality to predict the outcomes of comatose cardiac arrest survivors and supported the view that decisions to limit care should not be made based on the results of a single prognostication tool. Since then, some progress has been made. The 2015 guidelines highlight the need for a careful, daily, clinical neurological examination as the foundation for prognostication and reference the existence of multiple studies that support the use of multiple testing modalities that might be categorized as follows: clinical examination; neurophysiological studies - somatosensory evoked potentials and electroencephalography; biochemical markers - neuron-specific enolase as the most commonly used; imaging studies - brain computed tomography and magnetic resonance imaging (MRI).()
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