CARDIOPULMONARY RESUSCITATION: Edited by Bernd W. BöttigerNeurological prognostication after cardiac arrestSandroni, Claudioa; Geocadin, Romergryko G.b,c Author Information aDepartment of Anesthesiology and Intensive Care, Catholic University School of Medicine, Rome, Italy bDepartments of Neurology and Neurosurgery, Division of Neurosciences Critical Care Medicine cDepartment of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA Correspondence to Dr Romergryko G. Geocadin, Professor, Departments of Neurology, Anesthesiology-Critical Care Medicine, Neurological Surgery and Medicine, Division of Neurosciences Critical Care, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Phipps 455, Baltimore, MD 21287, USA. Tel: +1 410 955 7481; fax: +1 410 614 7903; e-mail: [email protected] Current Opinion in Critical Care: June 2015 - Volume 21 - Issue 3 - p 209-214 doi: 10.1097/MCC.0000000000000202 Buy Metrics Abstract Purpose of review Prediction of neurological prognosis in patients who are comatose after successful resuscitation from cardiac arrest remains difficult. Previous guidelines recommended ocular reflexes, somatosensory evoked potentials and serum biomarkers for predicting poor outcome within 72 h from cardiac arrest. However, these guidelines were based on patients not treated with targeted temperature management and did not appropriately address important biases in literature. Recent findings Recent evidence reviews detected important limitations in prognostication studies, such as low precision and, most importantly, lack of blinding, which may have caused a self-fulfilling prophecy and overestimated the specificity of index tests. Maintenance of targeted temperature using sedatives and muscle relaxants may interfere with clinical examination, making assessment of neurological status before 72 h or more after cardiac arrest unreliable. Summary No index predicts poor neurological outcome after cardiac arrest with absolute certainty. Prognostic evaluation should start not earlier than 72 h after ROSC and only after major confounders have been excluded so that reliable clinical examination can be made. Multimodality appears to be the most reasonable approach for prognostication after cardiac arrest. Copyright © 2015 YEAR Wolters Kluwer Health, Inc. All rights reserved.