Prognostication after cardiac arrest.
OBJECTIVE
The prognosis of patients with postanoxic coma (PAC) after cardiac arrest is a challenging task for clinicians. The need for early and accurate prognostic predictors is crucial. Treatment with therapeutic hypothermia and sedation alters the reliability of neurological examination. Considering the extensive literature existing on this topic, we aimed to provide a practical approach on how to predict outcome in patients with PAC, particularly in those treated with therapeutic hypothermia.


RESULTS
Recovery of motor responses can take several days and can therefore not be used to assess the extent of brain injury in the early phase after cardiac arrest. Additional tools, including electroencephalography, somatosensory-evoked potentials, biomarkers and radiological imaging, may help to determine the prognosis. Nevertheless, treatment with therapeutic hypothermia, including prolonged sedation, has changed the predictive value of these tools.


CONCLUSIONS
For reliable prediction of outcome in patients with PAC, various prognostic methods should be combined with the standard neurological examination in a multimodal approach.
aDepartment of Intensive Care, Academic Medical Center, Amsterdam, The Netherlands bDepartment of Clinical Sciences, Section for Neurology, Lund University Hospital, Lund University, Lund, Sweden cDepartment of Intensive Care, Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium.
Janneke
J
Horn
Tobias
T
Cronberg
Fabio S
FS
Taccone
D015415:Biomarkers; D001930:Brain Injuries / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy; D003128:Coma / Q000401:mortality / Q000503:physiopathology*; D004569:Electroencephalography; D005073:Evoked Potentials, Somatosensory; D005260:Female; D023261:Glasgow Outcome Scale; D006323:Heart Arrest / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods* / Q000401:mortality; D008279:Magnetic Resonance Imaging; D008297:Male; D011379:Prognosis; D015203:Reproducibility of Results
D015415:Biomarkers