Caralyn M Bencsik, Andreas H Kramer, Philippe Couillard, Maarit MacKay, Julie A Kromm
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引用次数: 0
Abstract
Background: Objective, evidence-based neuroprognostication of postarrest patients is crucial to avoid inappropriate withdrawal of life-sustaining therapies or prolonged, invasive, and costly therapies that could perpetuate suffering when there is no chance of an acceptable recovery. Postarrest prognostication guidelines exist; however, guideline adherence and practice variability are unknown.
Objective: To investigate Canadian practices and opinions regarding assessment of neurological prognosis in postarrest patients.
Methods: An anonymous electronic survey was distributed to physicians who care for adult postarrest patients.
Results: Of the 134 physicians who responded to the survey, 63% had no institutional protocols for neuroprognostication. While the use of targeted temperature management did not affect the timing of neuroprognostication, an increasing number of clinical findings suggestive of a poor prognosis affected the timing of when physicians were comfortable concluding patients had a poor prognosis. Variability existed in what factors clinicians' thought were confounders. Physicians identified bilaterally absent pupillary light reflexes (85%), bilaterally absent corneal reflexes (80%), and status myoclonus (75%) as useful in determining poor prognosis. Computed tomography, magnetic resonance imaging, and spot electroencephalography were the most useful and accessible tests. Somatosensory evoked potentials were useful, but logistically challenging. Serum biomarkers were unavailable at most centers. Most (79%) physicians agreed ≥2 definitive findings on neurologic exam, electrophysiologic tests, neuroimaging, and/or biomarkers are required to determine a poor prognosis with a high degree of certainty. Distress during the process of neuroprognostication was reported by 70% of physicians and 51% request a second opinion from an external expert.
Conclusion: Significant variability exists in post-cardiac arrest neuroprognostication practices among Canadian physicians.
期刊介绍：
Canadian Neurological Sciences Federation The Canadian Journal of Neurological Sciences is the official publication of the four member societies of the Canadian Neurological Sciences Federation -- Canadian Neurological Society (CNS), Canadian Association of Child Neurology (CACN), Canadian Neurosurgical Society (CNSS), Canadian Society of Clinical Neurophysiologists (CSCN). The Journal is a widely circulated internationally recognized medical journal that publishes peer-reviewed articles. The Journal is published in January, March, May, July, September, and November in an online only format. The first Canadian Journal of Neurological Sciences (the Journal) was published in 1974 in Winnipeg. In 1981, the Journal became the official publication of the member societies of the CNSF.
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