Postresuscitation encephalopathy. Current views, management, and prognostication

Cardiac arrest has a high mortality rate. Postresuscitation encephalopathy is commonly associated with significant morbidity.

Among those patients who achieve a return to spontaneous circulation, more than half die during the subsequent hospital course. Few survivors recover without significant neurologic disability. Clinical examination is often used for predicting subsequent neurologic outcome in these patients. The role of ancillary investigations and the judicious combination of these parameters with the findings on clinical examination to achieve accurate prognostication is discussed in this review. Only a few parameters have a strong predictive value in coma after cardiac arrest. These include pupillary light reflexes and motor responses at 3 days, absent somatosensory evoked potential, and possibly diffuse magnetic resonance imaging changes.

The authors discuss the physiology, pathology, and consequences of cardiac arrest to the central nervous system, and the use of various parameters in prognostication. Induced hypothermia is a new therapeutic development.