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  • 13-Neuroprognostication Algorithm 2021

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    khaled
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    This document provides guidance on neuroprognostication of comatose adult patients after cardiac arrest. It outlines criteria that when two or more are met, including no pupillary or corneal reflexes at 72 hours, absent N20 wave on EEG, malignant EEG patterns at 24 hours, high levels of neuron-specific enolase at 48 and 72 hours, or myoclonus within 72 hours, the prognosis is likely poor. If fewer than two criteria are met, the patient should be observed and re-evaluated.

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    This document provides guidance on neuroprognostication of comatose adult patients after cardiac arrest. It outlines criteria that when two or more are met, including no pupillary or corneal reflexes at 72 hours, absent N20 wave on EEG, malignant EEG patterns at 24 hours, high levels of neuron-specific enolase at 48 and 72 hours, or myoclonus within 72 hours, the prognosis is likely poor. If fewer than two criteria are met, the patient should be observed and re-evaluated.

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    © All Rights Reserved
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    9 views1 page

    13-Neuroprognostication Algorithm 2021

    Uploaded by

    khaled
    This document provides guidance on neuroprognostication of comatose adult patients after cardiac arrest. It outlines criteria that when two or more are met, including no pupillary or corneal reflexes at 72 hours, absent N20 wave on EEG, malignant EEG patterns at 24 hours, high levels of neuron-specific enolase at 48 and 72 hours, or myoclonus within 72 hours, the prognosis is likely poor. If fewer than two criteria are met, the patient should be observed and re-evaluated.

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    © All Rights Reserved
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    of 1

    Neuroprognostication

    of the comatose adult patient


    after resuscitation from cardiac arrest

    Targeted temperature
    management and rewarming

    Unconscious patient,
    M ≤ 3 at ≥ 72 h
    without confounders(1)

    YES

    At least TWO of:


    • No pupillary(2) and corneal reflexes at ≥72 h
    • Bilaterally absent N20 SSEP wave
    Poor
    • Highly malignant(3) EEG at >24 h
    YES outcome
    • NSE > 60 mcg/L-1(4) at 48 h and/or 72 h
    likely(*)
    • Status myoclonus(5) ≤ 72 h
    • Diffuse and extensive anoxic
    injury on brain CT/MR

    NO

    Observe and re-evaluate

    1
    Major confounders may include 3
    Suppressed background ± periodic 5
    Defined as a continuous and
    analgo-sedation, neuromuscular discharges or burst-suppression, generalised myoclonus persisting
    blockade, hypothermia, according to American Clinical for 30 min or more
    severe hypotension, Neurophysiology Society
    hypoglycaemia, sepsis, and *
    Caution in case of discordant
    metabolic and respiratory 4
    Increasing NSE values between signs indicating a potentially good
    derangements 24–48 h or 24/48 and 72 h further outcome
    support a likely poor outcome
    2
    Use an automated pupillometer,
    when available, to assess pupillary
    light reflex

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