title: How to assess prognosis after cardiac arrest and therapeutic hypothermia.
abstract: The prognosis of patients who are admitted in a comatose state following successful resuscitation after cardiac arrest remains uncertain. Although the introduction of therapeutic hypothermia (TH) and improvements in post-resuscitation care have significantly increased the number of patients who are discharged home with minimal brain damage, short-term assessment of neurological outcome remains a challenge. The need for early and accurate prognostic predictors is crucial, especially since sedation and TH may alter the neurological examination and delay the recovery of motor response for several days. The development of additional tools, including electrophysiological examinations (electroencephalography and somatosensory evoked potentials), neuroimaging and chemical biomarkers, may help to evaluate the extent of brain injury in these patients. Given the extensive literature existing on this topic and the confounding effects of TH on the strength of these tools in outcome prognostication after cardiac arrest, the aim of this narrative review is to provide a practical approach to post-anoxic brain injury when TH is used. We also discuss when and how these tools could be combined with the neurological examination in a multimodal approach to improve outcome prediction in this population.
authors.forename: Fabio
authors.initials: F
authors.lastname: Taccone
authors.forename: Tobias
authors.initials: T
authors.lastname: Cronberg
authors.forename: Hans
authors.initials: H
authors.lastname: Friberg
authors.forename: David
authors.initials: D
authors.lastname: Greer
authors.forename: Janneke
authors.initials: J
authors.lastname: Horn
authors.forename: Mauro
authors.initials: M
authors.lastname: Oddo
authors.forename: Sabino
authors.initials: S
authors.lastname: Scolletta
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Vincent
mesh_terms: D015415:Biomarkers; D001930:Brain Injuries / Q000175:diagnosis* / Q000209:etiology; D003128:Coma / Q000209:etiology; D004569:Electroencephalography / Q000379:methods; D005073:Evoked Potentials, Somatosensory; D005260:Female; D006323:Heart Arrest / Q000150:complications / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D011379:Prognosis
chemical_list: D015415:Biomarkers