Today we discuss neuroprognostication after cardiac arrest.
Time Zero Prognostication is Garbage
In 2015, the Interventional Cardiologists put out guidelines with a treatment algo that allowed withholding cath based on a number of prognostic features
- J Am Coll Cardiol. 2015 Jul, 66 (1) 62–73
From JACC Paper
-
: “Serial lactate determinations for prediction of outcome after cardiac arrest”. Medicine (Baltimore) 2004; 83: 274.
- Looked at levels at 48 hrs
-
: “The impact of severe acidemia on neurologic outcome of cardiac arrest survivors undergoing therapeutic hypothermia”. Resuscitation 2013; 84: 1723
- Looked at time of initiation of TH
- : “Geriatric experience following cardiac arrest at six interventional cardiology centers in the United States 2006-2011: interplay of age, do-not-resuscitate order, and outcomes”. Crit Care Med 2014; 42: 289.
- PROCAT (Parisian Region Out of hospital Cardiac ArresT) study with 435 cardiac arrest patients, there were 264 nonsurvivors, of whom 112 had a lactate level >7 mmol/l.
- Post-Rosc, difficult to say what is meant by hospital admission
Miracle2
Multi-Modal Prognostication
SSEPs
I strongly recommend paralyzing the patient with Nimbex or Roc during SSEP testing
Myoclonus
More on EMCrit
Additional New Information
Additional Resources
Now on to the Podcast
Editor-in-Chief, at EMCrit.org
An ED Intensivist from NY.
Professor
Nassau University Medical Center
No conflicts of interest (coi).
Professor
Nassau University Medical Center
No conflicts of interest (coi).
Latest posts by Scott Weingart, MD FCCM (see all)
- EMCrit 383 – The Ultrasound Hierarchy of Needs in Cardiac Arrest with Mike Prats - September 6, 2024
- EMCrit RACC Lit Review – September 2024 - September 3, 2024
- EMCrit 382 – A Deep Dive on Vasopressin: Timing, Push Dose Vaso and the Vasopressin Load Test - August 23, 2024
Scott – What you are saying about small community hospitals is patently offensive. In an era where trying to transfer a patient to a larger center frequently takes days to weeks, and where resources are scarce across the board, maligning the care given in community hospitals is very off-putting. Community hospitals (like ours) are staffed with excellent, board certified critical care docs (who listen to your podcast to be told our care is insufficient), who take pride in applying the standard of care to our patients. In a magical world where you must exist, I could simply transfer a patient… Read more »
I am sorry but the argument as presented by you is not sound. I would be overjoyed to have you on the show to debate this very question (though based on your anonymous posting–I doubt you would take me up on the offer). You seem to be conflating the excellence of the intensive care staff (which I am sure is true) with the services a small community shop can provide–the latter of which was what was discussed in the podcast. The standard of care for young viable cardiac arrest patients can be found with the services present in a level… Read more »