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Prognostication after cardiac arrest

Horn, Jannekea; Cronberg, Tobiasb; Taccone, Fabio S.c

Current Opinion in Critical Care: June 2014 - Volume 20 - Issue 3 - p 280–286
doi: 10.1097/MCC.0000000000000085

Purpose of review The prognosis of patients with postanoxic coma (PAC) after cardiac arrest is a challenging task for clinicians. The need for early and accurate prognostic predictors is crucial. Treatment with therapeutic hypothermia and sedation alters the reliability of neurological examination. Considering the extensive literature existing on this topic, we aimed to provide a practical approach on how to predict outcome in patients with PAC, particularly in those treated with therapeutic hypothermia.

Recent findings Recovery of motor responses can take several days and can therefore not be used to assess the extent of brain injury in the early phase after cardiac arrest. Additional tools, including electroencephalography, somatosensory-evoked potentials, biomarkers and radiological imaging, may help to determine the prognosis. Nevertheless, treatment with therapeutic hypothermia, including prolonged sedation, has changed the predictive value of these tools.

Summary For reliable prediction of outcome in patients with PAC, various prognostic methods should be combined with the standard neurological examination in a multimodal approach.

aDepartment of Intensive Care, Academic Medical Center, Amsterdam, The Netherlands

bDepartment of Clinical Sciences, Section for Neurology, Lund University Hospital, Lund University, Lund, Sweden

cDepartment of Intensive Care, Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium

Correspondence to Janneke Horn, Neurologist-Intensivist, Intensive Care Unit C3-329, Academical Medical Center, PO Box 22660, 1100DD Amsterdam, The Netherlands. Tel: +31 20 5662509; e-mail:

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins