title: A major miss in prognostication after cardiac arrest: Burst suppression and brain healing.
abstract: We report a case with therapeutic hypothermia after cardiac arrest where meaningful recovery far exceeded anticipated negative endpoints following cardiac arrest with loss of brainstem reflexes and subsequent status epilepticus. This man survived and recovered after an out-of-hospital cardiac arrest followed by a 6-week coma with absent motor responses and 5 weeks of burst suppression. Standard criteria suggested no chance of recovery. His recovery may relate to the effect of burst-suppression on EEG to rescue neurons near neuronal cell death. Further research to understand the mechanisms of therapeutic hypothermia and late restoration of neuronal functional capacity may improve prediction and aid end-of-life decisions after cardiac arrest.
authors.affiliation: Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA, United States.
authors.forename: Danielle A
authors.initials: DA
authors.lastname: Becker
authors.affiliation: Department of Neurology, Weill Cornell Medical Center, New York, NY, United States.
authors.forename: Nicholas D
authors.initials: ND
authors.lastname: Schiff
authors.affiliation: Department of Emergency Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, United States.
authors.forename: Lance B
authors.initials: LB
authors.lastname: Becker
authors.affiliation: Department of Neurology, New York University Medical Center, New York, NY, United States.
authors.forename: Manisha G
authors.initials: MG
authors.lastname: Holmes
authors.affiliation: Department of Internal Medicine, Weill Cornell Medical Center, New York, NY, United States.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Fins
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Weill Cornell Medical Center, New York, NY, United States.
authors.forename: James M
authors.initials: JM
authors.lastname: Horowitz
authors.affiliation: Department of Neurology, New York University Medical Center, New York, NY, United States.
authors.forename: Orrin
authors.initials: O
authors.lastname: Devinsky
keywords: Burst suppression; Cardiac arrest; Hypothermia; Prognostication; Status epilepticus