Neurological prognostication after cardiac arrest--recommendations from the Swedish Resuscitation Council.
Cardiopulmonary resuscitation is started in 5000 victims of out-of-hospital cardiac arrest in Sweden each year and the survival rate is approximately 10%. The subsequent development of a global ischaemic brain injury is the major determinant of the neurological prognosis for those patients who reach the hospital alive. Induced hypothermia is a recommended treatment after cardiac arrest and has been implemented in most Swedish hospitals. Recent studies indicate that induced hypothermia may affect neurological prognostication and previous international recommendations are therefore no longer valid when hypothermia is applied. An expert group from the Swedish Resuscitation Council has reviewed the literature and made recommendations taking into account the effects of induced hypothermia and concomitant sedation. A delayed neurological evaluation at 72 h after rewarming is recommended for hypothermia treated patients. This evaluation should be based on several independent methods and the possibility of lingering pharmacological effects should be considered.
Department of Clinical Sciences, Division of Neurology, Lund University, Lund, Sweden. Tobias.Cronberg@skane.se
Tobias
T
Cronberg
Marco
M
Brizzi
Lars Johan
LJ
Liedholm
Ingmar
I
Rosén
Sten
S
Rubertsson
Christian
C
Rylander
Hans
H
Friberg
D001921:Brain / Q000473:pathology; D001926:Brain Death / Q000175:diagnosis; D004569:Electroencephalography; D005073:Evoked Potentials, Somatosensory; D015600:Glasgow Coma Scale; D006323:Heart Arrest / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007036:Hypothermia, Induced; D008279:Magnetic Resonance Imaging; D009460:Neurologic Examination; D010751:Phosphopyruvate Hydratase / Q000097:blood; D011379:Prognosis; D017694:Rewarming; D064568:S100 Calcium Binding Protein beta Subunit / Q000097:blood; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D057832:Watchful Waiting
D064568:S100 Calcium Binding Protein beta Subunit; D010751:Phosphopyruvate Hydratase