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Neurological prognostication after cardiac arrest--recommendations from the Swedish Resuscitation Council

Tobias Cronberg1, Marco Brizzi, Lars Johan Liedholm

  • 1Department of Clinical Sciences, Division of Neurology, Lund University, Lund, Sweden. Tobias.Cronberg@skane.se

Resuscitation
|February 2, 2013
PubMed

Insights

Induced hypothermia impacts neurological prognostication after cardiac arrest. Delayed neurological evaluation at 72 hours post-rewarming is recommended for accuracy, considering sedation effects.

Area of Science:

  • Emergency Medicine
  • Neurology
  • Critical Care Medicine

Background:

  • Out-of-hospital cardiac arrest (OHCA) in Sweden affects 5000 individuals annually with a 10% survival rate.
  • Global ischemic brain injury significantly influences neurological outcomes in survivors.
  • Induced hypothermia is a standard post-cardiac arrest treatment, but affects prognostication.

Purpose of the Study:

  • To review and update neurological prognostication recommendations for cardiac arrest survivors treated with induced hypothermia.
  • To provide guidance considering the influence of hypothermia and sedation on neurological assessments.

Main Methods:

  • Literature review by an expert group from the Swedish Resuscitation Council.
  • Analysis of studies on induced hypothermia's effects on neurological prognostication.
  • Consideration of concomitant sedation's impact on patient evaluation.

Main Results:

  • Previous international recommendations for neurological prognostication are no longer valid with hypothermia use.
  • A delayed neurological evaluation is necessary for accurate assessment in hypothermia-treated patients.
  • Evaluation should incorporate multiple methods and account for potential pharmacological effects.

Conclusions:

  • Neurological prognostication after cardiac arrest requires revised strategies when induced hypothermia is applied.
  • A delayed evaluation at 72 hours after rewarming is crucial for reliable assessment.
  • Comprehensive evaluation methods are needed, acknowledging lingering sedation effects.

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