title: Early prognostication markers in cardiac arrest patients treated with hypothermia.
abstract: OBJECTIVE
  Established prognostication markers, such as clinical findings, electroencephalography (EEG) and biochemical markers, used by clinicians to predict neurological outcome after cardiac arrest (CA) are altered under therapeutic hypothermia (TH) conditions and their validity remains uncertain.
  
  
  METHODS
  MEDLINE and Embase were searched for evidence on the current standards for neurological outcome prediction for out-of-hospital CA patients treated with TH and the validity of a wide range of prognostication markers. Relevant studies that suggested one or several established biomarkers and multimodal approaches for prognostication are included and reviewed.
  
  
  RESULTS
  Whilst the prognostic accuracy of various tests after TH has been questioned, pupillary light reflexes and somatosensory evoked potentials are still strongly associated with negative outcome for early prognostication. Increasingly, EEG background activity has also been identified as a valid predictor for outcome after 72 h after CA and a preferred prognostic method in clinical settings. Neuroimaging techniques, such as magnetic resonance imaging and computed tomography, can identify functional and structural brain injury but are not readily available at the patient's bedside because of limited availability and high costs.
  
  
  CONCLUSIONS
  A multimodal algorithm composed of neurological examination, EEG-based quantitative testing and somatosensory evoked potentials, in conjunction with newer magnetic resonance imaging sequences, if available, holds promise for accurate prognostication in CA patients treated with TH. In order to avoid premature withdrawal of care, prognostication should be performed more than 72 h after CA.
authors.affiliation: Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: M
authors.initials: M
authors.lastname: Karapetkova
authors.affiliation: The Queen's Medical Center, Neuroscience Institute, Honolulu, HI, USA.|Department of Medicine, University of Hawaii John A. Burns School of Medicine, Honolulu, HI, USA.
authors.forename: M A
authors.initials: MA
authors.lastname: Koenig
authors.affiliation: Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA.|Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.|Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD, USA.|Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: X
authors.identifier: http://orcid.org/0000-0003-1445-8525
authors.initials: X
authors.lastname: Jia
mesh_terms: D015415:Biomarkers; D004569:Electroencephalography / Q000592:standards*; D005073:Evoked Potentials, Somatosensory / Q000502:physiology*; D006323:Heart Arrest / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D059906:Neuroimaging / Q000592:standards*; D009460:Neurologic Examination / Q000592:standards*; D017063:Outcome Assessment, Health Care
chemical_list: D015415:Biomarkers
keywords: brain injury; cardiac arrest; hypothermia; neuroimaging; neurological outcome; prognostication