Neuroprognostication after Cardiac Arrest

Neuroprognostication is one of the most controversial and sensitive examinations in the field of neurology. Neuroprognostication after cardiac arrest is a particularly important evaluation to complete as it is closely tied to the pathology of cardiac arrest and the time to return of spontaneous circulation (ROSC). With the improvement in healthcare, there are more survivors of cardiac arrest. These survivors have variable outcomes, and often, a difficult prognosis to interpret based on their clinical presentation with hypoxic brain injury. Many patients experience moderate to severe neurological impairment in the form of severe cognitive disability or persistent vegetative state. Withdrawal of life-sustaining measures inevitably leads to death, thus propagating neuroprognostication as a controversial tool used to guide these difficult decisions. Thorough evaluation and tests are required for prognostication, with new guidelines consistently being updated. The non-exhaustive list of tests includes pupillary light response, neurological motor response, computed tomography of the brain, magnetic resonance imaging of the brain, electro-encephalogram, somatosensory evoked potentials, and more. Testing variables and outcomes are also dependent on the patient’s clinical picture, including potential hypothermic status. Overall, neuroprognostication after cardiac arrest holds great value in guiding clinical decision-making with the help of physical exam skills, updated algorithmic decision-making guidelines, and technology.