Neuroprognostication postcardiac arrest: translating probabilities to individuals.

PURPOSE OF REVIEW: Predicting neurological recovery in patients who are comatose after cardiac arrest is an important activity during postarrest care, and this prediction can affect survival. As no early test or clinical finding perfectly predicts potential for recovery, guidelines recommend using data from multiple examinations or tests to estimate patient prognosis.

RECENT FINDINGS: Studies reported accuracy of initial clinical examination, progression of clinical examination, early (<24 h) brain imaging, electroencephalography (EEG), evoked potentials, later (>24 h) brain imaging, blood markers of brain injury, and cerebral oximetry for predicting good or poor outcome. In multiple cohorts, patients with status myoclonus with particular clinical or EEG features have potential for good outcome. When multiple tests were compared, each test provided independent information.

SUMMARY: Absence of cortical functional recovery over time is detected using multiple testing modalities and remains strongly associated with poor outcome. Early recovery of cortical function increases the probability of good outcome. Concordant assessments from multiple tests increase confidence in prognostication.