Decoding Neuroprognostication with Dr. Julie Kromm
Jan 23, 2024
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Dr. Julie Kromm, a neurointensivist and co-author of the Canadian Position Statement for Neuro Prognostication, discusses the challenges and importance of neuroprognostication after cardiac arrest. Topics include the pitfalls and biases in prognostication, various tests and imaging modalities, early potentials and EEGs, and the need for national expertise in neuro critical care.
Neuro-prognostication after cardiac arrest requires avoiding withdrawing life-sustaining measures too quickly to allow potential for a good outcome.
In neuro-prognostication, it is essential to balance the self-fulfilling prophecy and false hope while excluding confounders and remaining humble.
Deep dives
Passion for Neuro-Prognostication
Dr. Julie Crum explains her passion for neuro-prognostication after cardiac arrest, highlighting the lack of guiding evidence for certain conditions and the need to be well-prepared in making life-changing decisions.
Risk Factors and Balancing Hope
Dr. Crum discusses the risk factors for death after cardiac arrest and emphasizes the importance of not withdrawing life-sustaining measures too quickly, as patients with altered or comatose states still have potential for a good outcome.
Pitfalls in Neuro-Prognostication
Dr. Crum outlines the major pitfalls to avoid in neuro-prognostication, emphasizing the importance of balancing the self-fulfilling prophecy and false hope, as well as the need to exclude confounders and remain humble to overcome biases.
Clinical Exam and Special Testing
Dr. Crum explores the clinical exam and special testing in neuro-prognostication. She discusses the limitations of certain neurological exam findings and shares insights on when to believe them. She also delves into the three categories of special testing - neuroimaging, electrophysiological tests, and biomarkers - and provides practical considerations and timing guidelines for each.
Welcome to our next episode! In this episode, we again delve into the world of neuroprognostication with none other than Dr. Julie Kromm. Dr Kromm is a neurointensivist, who brings a wealth of expertise to the table and was one of the authors on the Canadian Position Statement for Neuro Prognostication after cardiac arrest.
Neuroprognostication is a field that combines the precision of neurology with the nuances of predicting outcomes in patients with severe neurological injury after cardiac arrest. Join us as Dr. Kromm guides us through looking behind the fog, using the physical examination appropriately and what to make of special testing.
Further Reading:
1. Neuroprognostication in the Post Cardiac Arrest Patient: A Canadian Cardiovascular Society Position Statemen. https://doi.org/10.1016/j.cjca.2022.12.014
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