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
- Miracle 2 Score is interesting, but needs validation and assessment as to whether therapeutic nihilism contributed (so needs RCT)
I strongly recommend paralyzing the patient with Nimbex or Roc during SSEP testing