Critical Matters Neuroprognostication after Cardiac Arrest
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Apr 28, 2022 Dr. Neha Dangayach, a neurocritical care physician at Mount Sinai, dives deep into neuroprognostication after cardiac arrest. She highlights the evolution of prognosis methodologies, emphasizing the importance of multimodal testing beyond a single exam. Uncertainty in outcomes is addressed, stressing shared decision-making to avoid premature life support withdrawal. Dr. Dangayach also discusses influential factors like arrest history, temperature, and biomarkers, urging a cautious approach to brain death declarations and the necessity for ongoing assessments post-arrest.
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Control Confounders Before Interpreting Exam
- Identify and account for confounders: temperature, sedatives, paralytics, and organ failure.
- Consult ICU pharmacists and delay prognosis until drug effects and metabolic disturbances clear.
Follow Protocols For Brain Death Carefully
- Follow local/state brain death protocols and confirm structural severe brain injury first.
- Repeat neuroimaging before declaring brain death outside typical time windows.
Do Baseline And Serial Neurological Exams
- Perform an initial physical exam before starting targeted temperature management.
- Document serial brainstem and motor responses and use pupillometry if available.
