Prognostication and management of patients who are comatose after cardiac arrest

Abstract

The development of cardiopulmonary resuscitation by Peter Safar and others has had the unintended consequence of increasing the number of patients surviving in coma from hypoxic-ischemic encephalopathy. Neurologists often assess the prognosis for functional recovery of these patients, communicate this prognostic information to the patient’s family, and help manage the patient through the initial post-arrest period and through subsequent recovery, rehabilitation, or transition to palliative management. Prognostication in the United States has predominantly been based on physical findings elicited at defined time points after resuscitation, typically using data from the work of the Cornell group.1,2 In the past 25 years, many have attempted to improve prognostication by adding electrophysiologic or biochemical tests. Of the electrophysiologic studies tested, short-latency somatosensory evoked potentials (SSEPs) emerged as the most robust predictor of poor outcome: loss of the cortical …