Survey on current practices for neurological prognostication after cardiac arrest |
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| Affiliation: | 1. Skåne University Hospital, Department of Anaesthesiology and Intensive Care, Lund University, Sweden;2. Skåne University Hospital, Department of Neurology, Lund University, Sweden;3. Salzburg General Hospital and Paracelsus Private Medical University, Salzburg, Austria;4. Department of Anaesthesia and Intensive Care, Bicêtre Hospital, Hôpitaux universitaires Paris-Sud, Université Paris-Sud, Assistance Publique – Hôpitaux de Paris, 94275 Le Kremlin Bicêtre, France;5. Academic Medical Center, Department of Intensive Care, Amsterdam, The Netherlands;6. Department of Intensive Care Medicine, CHUV-Lausanne University, Switzerland;1. Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany;2. German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg 69120, Germany;3. Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany;1. Department of Emergency Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea;2. Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea;1. Department of Medicine, Division of Critical Care Medicine, University of British Columbia, Vancouver, BC, Canada;2. Department of Anesthesia, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada;3. Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada;1. Service de Réanimation des Urgences et médicale, Hôpital de la Timone, Marseille, France;2. Service de Neurophysiologie Clinique, Hôpital de la Timone, Marseille, France;1. Department of Emergency and Critical Care, Nagoya University Graduate School of Medicine, Nagoya, Japan;2. Advanced Medical Emergency Department and Critical Care Center, Japan Red Cross Maebashi Hospital, Maebashi, Japan;3. Department of Biostatistics, Nagoya University Graduate School of Medicine, Nagoya, Japan |
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| Abstract: | PurposeTo investigate current practices and timing of neurological prognostication in comatose cardiac arrest patients.MethodsAn anonymous questionnaire was distributed to the 8000 members of the European Society of Intensive Care Medicine during September and October 2012. The survey had 27 questions divided into three categories: background data, clinical data, decision-making and consequences.ResultsA total of 1025 respondents (13%) answered the survey with complete forms in more than 90%. Twenty per cent of respondents practiced outside of Europe. Overall, 22% answered that they had national recommendations, with the highest percentage in the Netherlands (>80%). Eighty-nine per cent used induced hypothermia (32–34 °C) for comatose cardiac arrest patients, while 11% did not. Twenty per cent had separate prognostication protocols for hypothermia patients. Seventy-nine per cent recognized that neurological examination alone is not enough to predict outcome and a similar number (76%) used additional methods. Intermittent electroencephalography (EEG), brain computed tomography (CT) scan and evoked potentials (EP) were considered most useful. Poor prognosis was defined as cerebral performance category (CPC) 3–5 (58%) or CPC 4–5 (39%) or other (3%). When prognosis was considered poor, 73% would actively withdraw intensive care while 20% would not and 7% were uncertain.ConclusionNational recommendations for neurological prognostication after cardiac arrest are uncommon and only one physician out of five uses a separate protocol for hypothermia treated patients. A neurological examination alone was considered insufficient to predict outcome in comatose patients and most respondents advocated a multimodal approach: EEG, brain CT and EP were considered most useful. Uncertainty regarding neurological prognostication and decisions on level of care was substantial. |
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| Keywords: | Cardiac arrest Outcome Prognostication Coma Survey |
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