Neuroprognostication in the Post Cardiac Arrest Patient: A Canadian Cardiovascular Society Position Statement

Primary Panel; Christopher B Fordyce; Andreas H Kramer; Craig Ainsworth; Jim Christenson; Gary Hunter; Julie Kromm; Carmen Lopez Soto; Damon C Scales; Mypinder Sekhon; Sean van Diepen; Laura Dragoi; Colin Josephson; Jim Kutsogiannis; Michel R Le May; Christopher B Overgaard; Martin Savard; Gregory Schnell; Graham C Wong; Emilie Belley-Côté; Secondary Panel; Tadeu A Fantaneanu; Christopher B Granger; Adriana Luk; Rebecca Mathew; Victoria McCredie; Laurel Murphy; Jeanne Teitelbaum

doi:10.1016/j.cjca.2022.12.014

Neuroprognostication in the Post Cardiac Arrest Patient: A Canadian Cardiovascular Society Position Statement

Can J Cardiol. 2023 Apr;39(4):366-380. doi: 10.1016/j.cjca.2022.12.014.

Authors

Primary Panel; Christopher B Fordyce¹, Andreas H Kramer², Craig Ainsworth³, Jim Christenson⁴, Gary Hunter⁵, Julie Kromm², Carmen Lopez Soto⁶, Damon C Scales⁷, Mypinder Sekhon⁸, Sean van Diepen⁹, Laura Dragoi⁷, Colin Josephson², Jim Kutsogiannis¹⁰, Michel R Le May¹¹, Christopher B Overgaard¹², Martin Savard¹³, Gregory Schnell¹⁴, Graham C Wong¹⁵, Emilie Belley-Côté³; Secondary Panel; Tadeu A Fantaneanu¹⁶, Christopher B Granger¹⁷, Adriana Luk¹⁸, Rebecca Mathew¹⁹, Victoria McCredie²⁰, Laurel Murphy²¹, Jeanne Teitelbaum²²

Affiliations

¹ Division of Cardiology, Department of Medicine, Vancouver General Hospital, and the Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia. Electronic address: cfordyce@mail.ubc.ca.
² Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta; Department of Critical Care, University of Calgary, Alberta.
³ Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
⁴ Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia.
⁵ Division of Neurology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
⁶ Department of Critical Care, King's College Hospital NHS Foundation Trust, London, United Kingdom.
⁷ Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada.
⁸ Division of Critical Care, Department of Medicine, Vancouver General Hospital, Djavad Mowafaghian Centre for Brain Health, International Centre for Repair Discoveries, University of British Columbia, Vancouver, British Columbia.
⁹ Department of Critical Care Medicine, University of Alberta, Edmonton, Alberta; Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta.
¹⁰ Department of Critical Care Medicine, University of Alberta, Edmonton, Alberta.
¹¹ Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
¹² Division of Cardiology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
¹³ Department of Neurological Sciences CHU de Québec - Hôpital de l'Enfant-Jésus Quebec City, Quebec, Canada.
¹⁴ Division of Cardiology, Department of Medicine, University of Calgary, Calgary, Alberta.
¹⁵ Division of Cardiology, Department of Medicine, Vancouver General Hospital, and the Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia.
¹⁶ Division of Neurology, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada.
¹⁷ Duke Clinical Research Institute, Durham, North Carolina, USA.
¹⁸ Division of Cardiology, Department of Medicine, University of Toronto and the Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada.
¹⁹ CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, and the Faculty of Medicine, Division of Critical Care, University of Ottawa, Ottawa, Ontario, Canada.
²⁰ Interdepartmental Division of Critical Care Medicine, University of Toronto, the Krembil Research Institute, Toronto Western Hospital, University Health Network, and Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
²¹ Departments of Emergency Medicine and Critical Care, Dalhousie University, Halifax, Nova Scotia, Canada.
²² Neurological Intensive Care Unit, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada.

PMID: 37028905
DOI: 10.1016/j.cjca.2022.12.014

Abstract

Cardiac arrest (CA) is associated with a low rate of survival with favourable neurologic recovery. The most common mechanism of death after successful resuscitation from CA is withdrawal of life-sustaining measures on the basis of perceived poor neurologic prognosis due to underlying hypoxic-ischemic brain injury. Neuroprognostication is an important component of the care pathway for CA patients admitted to hospital but is complex, challenging, and often guided by limited evidence. Using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system to evaluate the evidence underlying factors or diagnostic modalities available to determine prognosis, recommendations were generated in the following domains: (1) circumstances immediately after CA; (2) focused neurologic exam; (3) myoclonus and seizures; (4) serum biomarkers; (5) neuroimaging; (6) neurophysiologic testing; and (7) multimodal neuroprognostication. This position statement aims to serve as a practical guide to enhance in-hospital care of CA patients and emphasizes the adoption of a systematic, multimodal approach to neuroprognostication. It also highlights evidence gaps.

Publication types

Practice Guideline

MeSH terms

Biomarkers
Canada / epidemiology
Heart Arrest* / diagnosis
Heart Arrest* / etiology
Heart Arrest* / therapy
Humans
Prognosis
Resuscitation

Substances

Biomarkers