🧠 Post-Cardiac-Arrest Neuroprognostication
Multimodal neuroprognostication for comatose survivors of cardiac arrest, requiring concordant unfavorable indicators after a defined delay.
Post-Cardiac-Arrest Neuroprognostication
Assessment timing
Bilateral pupillary + corneal reflexes absent (≥ 72 h)
Bilateral N20 (SSEP) absent
Highly malignant EEG (> 24 h, suppression/burst-suppression)
NSE > 60 µg/L (48 and/or 72 h)
Status myoclonus (≤ 72 h, early generalized)
CT/MRI diffuse extensive anoxic injury
When to use
Use ≥ 72 h after ROSC, with confounders excluded, to combine clinical, electrophysiologic, biomarker, and imaging indicators.
How it works
At ≥ 72 h in a comatose patient (M ≤ 3), ≥ 2 concordant unfavorable indicators (absent pupillary/corneal reflexes, absent bilateral N20, malignant EEG, NSE > 60, status myoclonus, diffuse anoxic injury on CT/MRI) suggest poor prognosis; no single indicator decides.
Key points
- Premature assessment (< 72 h or with sedation/hypothermia confounders) is unreliable and risks inappropriate withdrawal of care (original synthesis · not guideline verbatim).
- A single positive indicator is insufficient; at least two concordant findings plus multidisciplinary consensus are required.
- Absent motor response or the GCS-M item alone has a high false-positive rate and must not determine prognosis.
References
- Nolan JP, et al. ERC-ESICM post-resuscitation care guidelines. Intensive Care Med 2021.
- Sandroni C, et al. Neuroprognostication after cardiac arrest. Intensive Care Med 2022.
Decision support for licensed clinicians only; not a substitute for clinical judgement, diagnosis or local protocols.