Neuroprognostication After Cardiac Arrest

Cardiac arrest is a significant cause of mortality and morbidity. Despite advances in technologies and resuscitative care, patients who remain comatose after cardiac arrest present the bedside clinician with both diagnostic and therapeutic uncertainty because of variable comfort with how best to neuroprognosticate. Recent guidelines attempt to address existing knowledge gaps; however, significant variability remains in clinical practice, including the application of guideline recommendations at the bedside. We present a case-based discussion to illustrate key principles for early care and a subsequent approach to neuroprognostication. We explore many of the clinical nuances in neuroprognostication, including the utility of the clinical examination combined with either neuroimaging or neurophysiologic studies, in helping to care for these patients and support their families in decision-making processes. We discuss how a multimodal approach to neuroprognostication may be subject to site-specific availability of testing. Furthermore, how to incorporate the multidisciplinary team in patient care, including subspecialty services such as neurology and palliative care, is discussed when faced with complex clinical situations.