Cardiac arrest resuscitation: Neurologic prognostication and brain death

PURPOSE OF REVIEW: Persistent coma after cardiac arrest is a source of great emotional and financial cost to grieving family members in particular and the healthcare system in general. Neurologic prognostication helps guide appropriate discussions between family members and healthcare providers. Recent advances in therapeutic care increase the challenges, both medical and financial, on local practitioners. RECENT FINDINGS: Evidence-based reviews by prestigious associations add additional support and guidance to the practitioner who must guide family members in this very difficult decision process. Therapeutic hypothermia may alter findings, thus skewing the prognostic abilities of many accepted methodologies. This study reviews the usefulness of clinical examination, electrophysiologic studies, biochemical markers, and imaging modalities in predicting poor neurologic recovery in comatose survivors after cardiac arrest resuscitation. Some data from studies of therapeutic hypothermia are presented. SUMMARY: Evidence-based tests of prognostication for neurologic outcome after cardiac arrest are presented. A review of the practice of withdrawal of life-sustaining therapies and the diagnosis of brain death is also provided. The reader is cautioned that most prognostic studies do not include possible amelioration with the use of therapeutic hypothermia.