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. 2008 Sep 15:16:9.
doi: 10.1186/1757-7241-16-9.

Prognostication after out-of-hospital cardiac arrest, a clinical survey

Michael Busch  1 , Eldar Søreide
Affiliations

Prognostication after out-of-hospital cardiac arrest, a clinical survey

Michael Busch et al. Scand J Trauma Resusc Emerg Med. .

Abstract

Background: Numerous parameters and tests have been proposed for outcome prediction in comatose out-of-hospital cardiac arrest survivors. We conducted a survey of clinical practice of prognostication after therapeutic hypothermia (TH) became common practice in Norway.

Methods: By telephone, we interviewed the consultants who were in charge of the 25 ICUs admitting cardiac patients using 6 structured questions regarding timing, tests used and medical specialties involved in prognostication, as well as the clinical importance of the different parameters used and the application of TH in these patients.

Results: Prognostication was conducted within 24-48 hours in the majority (72%) of the participating ICUs.The most commonly applied parameters and tests were a clinical neurological examination (100%), prehospital data (76%), CCT (56%) and EEG (52%). The parameters and tests considered to be of greatest importance for accurate prognostication were prehospital data (56%), neurological examination (52%), and EEG (20%).In 76% of the ICUs, a multidisciplinary approach to prognostication was applied, but only one ICU used a standardised protocol. Therapeutic hypothermia was in routine use in 80% of the surveyed ICUs.

Conclusion: Despite the routine use of TH, outcome prediction was performed early and was mainly based on prehospital information, neurological examination and CCT and EEG evaluation. Somatosensory evoked potentials appear to be underused and underrated, while the importance of prehospital data, CCT and EEG to appear to be overrated as methods for making accurate predictions.More evidence-based protocols for prognostication in cardiac arrest survivors, as well as additional studies on the effect of TH on known prognostic parameters are needed.

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Figures

Figure 1
Figure 1
Applied prognostic parameters. Figure 1 depicts the frequency of application of different prognostic parameters.
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References

    1. Atwood C, Eisenberg MS, Herlitz J, Rea TD. Incidence of EMS-treated out-of-hospital cardiac arrest in Europe. Resuscitation. 2005;67:75–80. doi: 10.1016/j.resuscitation.2005.03.021. - DOI - PubMed
    1. Holzer M, Sterz F. Therapeutic hypothermia after cardiopulmonary resuscitation. Expert Rev Cardiovasc Ther. 2003;1:317–325. doi: 10.1586/14779072.1.2.317. - DOI - PubMed
    1. Booth CM, Boone RH, Tomlison G, Detsky AS. Is this patient dead, vegetative, or severely neurologically impaired? Assessing outcome for comatose survivors of cardiac arrest. JAMA. 2004;291:870–9. doi: 10.1001/jama.291.7.870. - DOI - PubMed
    1. Laver S, Farrow C, Turner D, Nolan J. Mode of death after admission to an intensive care unit following cardiac arrest. Intensive Care Med. 2004;30:2126–2128. doi: 10.1007/s00134-004-2425-z. - DOI - PubMed
    1. Busch M, Soreide E, Lossius HM, Lexow K, Dickstein K. Rapid implementation of therapeutic hypothermia in comatose out-of-hospital cardiac arrest survivors. Acta Anaesthesiol Scand. 2006;50:1277–83. doi: 10.1111/j.1399-6576.2006.01147.x. - DOI - PubMed

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