Critical Matters Neuroprognostication after Cardiac Arrest
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Jun 10, 2019 In this discussion, Fred Rincon, a board-certified neurologist and neurointensivist at Thomas Jefferson University, explores neuroprognostication after cardiac arrest. He emphasizes the importance of waiting 72 hours post-rewarming before making prognosis decisions, given advancements like targeted temperature management. Rincon explains how physical exams and biomarkers can aid in predicting recovery while highlighting their limitations. He also discusses aggressive treatment of myoclonic patterns and the role of imaging in the prognostication process.
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Delay Early Prognostication
- Wait before prognosticating after cardiac arrest; early conclusions are often wrong.
- Use targeted temperature management and be conservative when assessing recovery potential.
Hypothermia Alters Prognostic Rules
- Hypothermia/temperature management has changed outcomes and the natural history of anoxic brain injury.
- Pre-hypothermia prognostic rules may no longer apply and need re-evaluation.
Prioritize Post-Rewarming Exam
- Rely on the physical exam after rewarming: pupillary reflexes and motor responses predict outcome.
- Assess these findings after the standard cooling and rewarming period, not immediately post-ROSC.
