Survey on current practices for neurological prognostication after cardiac arrest

Hans Friberg, Tobias Cronberg, Martin W. Dünser, Jacques Duranteau, Janneke Horn, Mauro Oddo

Research output: Contribution to journalArticleResearchpeer-review

60 Citations (Scopus)

Abstract

Purpose: To investigate current practices and timing of neurological prognostication in comatose cardiac arrest patients. Methods: An anonymous questionnaire was distributed to the 8000 members of the European Society of Intensive Care Medicine during September and October 2012. The survey had 27 questions divided into three categories: background data, clinical data, decision-making and consequences. Results: A total of 1025 respondents (13%) answered the survey with complete forms in more than 90%. Twenty per cent of respondents practiced outside of Europe. Overall, 22% answered that they had national recommendations, with the highest percentage in the Netherlands (>80%). Eighty-nine per cent used induced hypothermia (32-34. °C) for comatose cardiac arrest patients, while 11% did not. Twenty per cent had separate prognostication protocols for hypothermia patients. Seventy-nine per cent recognized that neurological examination alone is not enough to predict outcome and a similar number (76%) used additional methods. Intermittent electroencephalography (EEG), brain computed tomography (CT) scan and evoked potentials (EP) were considered most useful. Poor prognosis was defined as cerebral performance category (CPC) 3-5 (58%) or CPC 4-5 (39%) or other (3%). When prognosis was considered poor, 73% would actively withdraw intensive care while 20% would not and 7% were uncertain. Conclusion: National recommendations for neurological prognostication after cardiac arrest are uncommon and only one physician out of five uses a separate protocol for hypothermia treated patients. A neurological examination alone was considered insufficient to predict outcome in comatose patients and most respondents advocated a multimodal approach: EEG, brain CT and EP were considered most useful. Uncertainty regarding neurological prognostication and decisions on level of care was substantial.

Original languageEnglish
Pages (from-to)158-162
Number of pages5
JournalResuscitation
Volume90
DOIs
Publication statusPublished - May 2015
Externally publishedYes

Keywords

  • Cardiac arrest
  • Coma
  • Outcome
  • Prognostication
  • Survey

Cite this