Abstract 253: The Recovery of Consciousness via Evidence-Based Medicine and Research Program: An Innovative Paradigm for Advancing Neuroprognostication After Cardiac Arrest

Abstract

Introduction: Prognostication of neurologic recovery in post-cardiac arrest coma often dictates whether life-sustaining treatments are continued or withdrawn. However, the conventional approach to prognostication is fragmented and inconsistent, impeding clinical care, research and education. Goals: We sought to establish an innovative approach to prognostication -- the Re covery of Co nsciousness V ia E vidence-Based Medicine and R esearch (RECOVER) program -- that provides specialized, comprehensive, and longitudinal care. Methods: Inpatients with post-arrest coma are evaluated by a dedicated RECOVER consult service, which collects data per evidence-based guidelines and advises clinical teams and families. Patients are discussed in a weekly interdisciplinary conference (with neurology, physiatry, radiology, palliative care, social work, physical therapy, ethics, and others) to formulate holistic prognostic determinations and treatment plans. For surviving patients, the RECOVER program provides continuity through partnered post-acute facilities and outpatient clinics. This clinical infrastructure is leveraged to build a registry of clinical data and outcomes. Trainees are incorporated throughout. Results: Between August 2022 and June 2023, the RECOVER program evaluated 70 patients with post-arrest coma (mean age 55y [SD = 16]). Of those, 34 (49%) survived to hospital discharge without transition to hospice care. Of the 25 patients ≥3 months from discharge, four have returned to clinic (16%). Functional MRIs are interpreted with the aid of neuroradiology and ethics. Preliminary data suggest high caregiver satisfaction with the RECOVER program (mean of 4.7 on a 5-point Likert scale). Conclusion: The RECOVER program enables systematic, guideline-based and interdisciplinary care, provides continuity, and facilitates clinical translation of research in patients with post-arrest coma. The RECOVER program helps provide ongoing healthcare access to this vulnerable population, although clinic retention is low. The RECOVER program also promotes trainee education and serves as an effective platform for data collection. If adopted broadly, the RECOVER program may advance post-arrest care and facilitate multi-center research.