Critical Matters Neuroprognostication after Cardiac Arrest
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Apr 28, 2022 Dr. Neha Dangayach, a neurocritical care physician at Mount Sinai, dives deep into neuroprognostication after cardiac arrest. She highlights the evolution of prognosis methodologies, emphasizing the importance of multimodal testing beyond a single exam. Uncertainty in outcomes is addressed, stressing shared decision-making to avoid premature life support withdrawal. Dr. Dangayach also discusses influential factors like arrest history, temperature, and biomarkers, urging a cautious approach to brain death declarations and the necessity for ongoing assessments post-arrest.
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Certainty Declined As Knowledge Grew
- Our certainty in neuroprognostication has decreased as knowledge and interventions evolved.
- Multimodal assessment and prognostic humility are now essential to avoid false certainty.
Always Use Multimodal Prognostication
- Use multimodal prognostication because no single test gives 100% sensitivity or specificity.
- Combine clinical exam, biomarkers, imaging, and electrophysiology before making decisions.
Delay Definitive Prognosis; Be Humble
- Acknowledge uncertainty and practice prognostic humility in family discussions.
- Wait at least 72 hours and perform serial assessments before firm prognoses, especially with confounders.
