title: Prognostication in comatose survivors of cardiac arrest: an advisory statement from the European Resuscitation Council and the European Society of Intensive Care Medicine.
abstract: OBJECTIVE
  To review and update the evidence on predictors of poor outcome (death, persistent vegetative state or severe neurological disability) in adult comatose survivors of cardiac arrest, either treated or not treated with controlled temperature, to identify knowledge gaps and to suggest a reliable prognostication strategy.
  
  
  METHODS
  GRADE-based systematic review followed by expert consensus achieved using Web-based Delphi methodology, conference calls and face-to-face meetings. Predictors based on clinical examination, electrophysiology, biomarkers and imaging were included.
  
  
  CONCLUSIONS
  Evidence from a total of 73 studies was reviewed. The quality of evidence was low or very low for almost all studies. In patients who are comatose with absent or extensor motor response at ≥72 h from arrest, either treated or not treated with controlled temperature, bilateral absence of either pupillary and corneal reflexes or N20 wave of short-latency somatosensory evoked potentials were identified as the most robust predictors. Early status myoclonus, elevated values of neuron specific enolase at 48 72 h from arrest, unreactive malignant EEG patterns after rewarming, and presence of diffuse signs of postanoxic injury on either computed tomography or magnetic resonance imaging were identified as useful but less robust predictors. Prolonged observation and repeated assessments should be considered when results of initial assessment are inconclusive. Although no specific combination of predictors is sufficiently supported by available evidence, a multimodal prognostication approach is recommended in all patients.
authors.forename: Claudio
authors.initials: C
authors.lastname: Sandroni
authors.forename: Alain
authors.initials: A
authors.lastname: Cariou
authors.forename: Fabio
authors.initials: F
authors.lastname: Cavallaro
authors.forename: Tobias
authors.initials: T
authors.lastname: Cronberg
authors.forename: Hans
authors.initials: H
authors.lastname: Friberg
authors.forename: Cornelia
authors.initials: C
authors.lastname: Hoedemaekers
authors.forename: Janneke
authors.initials: J
authors.lastname: Horn
authors.forename: Jerry P
authors.initials: JP
authors.lastname: Nolan
authors.forename: Andrea O
authors.initials: AO
authors.lastname: Rossetti
authors.forename: Jasmeet
authors.initials: J
authors.lastname: Soar
mesh_terms: D000328:Adult; D026683:Advisory Committees; D003128:Coma / Q000175:diagnosis* / Q000209:etiology; D003422:Critical Care; D005060:Europe; D006323:Heart Arrest / Q000150:complications / Q000628:therapy*; D006801:Humans; D011379:Prognosis; D012151:Resuscitation / Q000592:standards*; D012955:Societies, Medical; D017741:Survivors