Outcome and prognostication after cardiac arrest

Theresa Henson, Cameron Rawanduzy, Marco Salazar, Adonai Sebastian, Harli Weber, Fawaz Al-Mufti, Stephan A. Mayer

Research output: Contribution to journalReview articlepeer-review

14 Scopus citations

Abstract

The outcome after out-of-hospital cardiac arrest has historically been grim at best. The current overall survival rate of patients admitted to a hospital is approximately 10%, making cardiac arrest one of the leading causes of death in the United States. The situation is improving with the incorporation of therapeutic temperature modulation, aggressive prevention of secondary brain injury, and improved access to advanced cardiovascular support, all of which have decreased mortality and allowed for better outcomes. Mortality after cardiac arrest is often the direct result of active withdrawal of life-sustaining therapy based on the perception that neurological recovery is not possible. This reality highlights the importance of providing accurate estimates of neurological prognosis to decision makers when discussing goals of care. The current standard of care for assessing neurological status in patients with hypoxic-ischemic encephalopathy emphasizes a multimodal approach that includes five elements: (1) neurological examination off sedation, (2) continuous electroencephalography, (3) serum neuron-specific enolase levels, (4) magnetic resonance brain imaging, and (5) somatosensory-evoked potential testing. Sophisticated decision support systems that can integrate these clinical, imaging, and biomarker and neurophysiologic data and translate it into meaningful projections of neurological outcome are urgently needed.

Original languageEnglish
Pages (from-to)23-34
Number of pages12
JournalAnnals of the New York Academy of Sciences
Volume1508
Issue number1
DOIs
StatePublished - Feb 2022
Externally publishedYes

Keywords

  • cardiac arrest
  • neuroprognostication
  • outcomes
  • therapeutic hypothermia
  • therapeutic temperature modulation

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