Neuroprognostication in the Post Cardiac Arrest Patient: A Canadian Cardiovascular Society Position Statement.

Abstract

Cardiac arrest (CA) is associated with a low rate of survival with favourable neurologic recovery. The most common mechanism of death after successful resuscitation from CA is withdrawal of life-sustaining measures on the basis of perceived poor neurologic prognosis due to underlying hypoxic-ischemic brain injury. Neuroprognostication is an important component of the care pathway for CA patients admitted to hospital but is complex, challenging, and often guided by limited evidence. Using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system to evaluate the evidence underlying factors or diagnostic modalities available to determine prognosis, recommendations were generated in the following domains: (1) circumstances immediately after CA; (2) focused neurologic exam; (3) myoclonus and seizures; (4) serum biomarkers; (5) neuroimaging; (6) neurophysiologic testing; and (7) multimodal neuroprognostication. This position statement aims to serve as a practical guide to enhance in-hospital care of CA patients and emphasizes the adoption of a systematic, multimodal approach to neuroprognostication. It also highlights evidence gaps.

• Authors: Primary Panel, Christopher B Fordyce, Andreas H Kramer, Craig Ainsworth, Jim Christenson, Gary Hunter, Julie Kromm, Carmen Lopez Soto, Damon C Scales, Mypinder Sekhon, Sean van Diepen, Laura Dragoi, Colin Josephson, Jim Kutsogiannis, Michel R Le May, Christopher B Overgaard, Martin Savard, Gregory Schnell, Graham C Wong, Emilie Belley-Côté, Secondary Panel, Tadeu A Fantaneanu, Christopher B Granger, Adriana Luk, Rebecca Mathew, Victoria McCredie, Laurel Murphy, Jeanne Teitelbaum
• Journal: The Canadian journal of cardiology (Can J Cardiol) Vol. 39 Issue 4 Pg. 366-380 (04 2023) ISSN: 1916-7075 [Electronic] England
• PMID: 37028905 (Publication Type: Practice Guideline, Journal Article)
• Copyright: Copyright © 2022 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

Chemical References

• Biomarkers

Topics

• Humans
• Canada (epidemiology)
• Heart Arrest (diagnosis, etiology, therapy)
• Prognosis
• Biomarkers
• Resuscitation