Hypoxic-Ischemic Injury After Cardiac Arrest

Fig. 17.1
Evaluation of hypoxic ischemic injury algorithm. S sedatives, A analgesics, B neuromuscular junction blockers, H hypothermia

MRI may become abnormal if repeated, but there are patients with repeatedly normal MRI who never awaken only to demonstrate generalized brain atrophy later.

17.3.5 Prognostication Summary

Anoxic-ischemic injury remains the primary cause of disability post-cardiac arrest [10]. Targeted hypothermia is standard of care in many hospitals with modern ICUs, but the practice varies. Uncertainties about the timing of initial therapy, duration of therapy, best means to cool, and target temperature during therapeutic hypothermia exist. Prognostication in these comatose patients remains unreliable if there is (1) no myoclonus status, (2) present brainstem reflexes, (3) no suppression of EEG background or burst suppression pattern, (4) normal or near normal MRI, and (5) normal SSEPs. This means that in the majority of patients, outcome cannot be clearly established in the first weeks. Failure to improve motor response to localization implies longstanding cognitive deficits and even failure to awaken beyond a minimally conscious state. Neurologic assessment remains key and cannot be replaced by any ancillary test. Thus, neurologists and neurology specialty trained providers will continue to be consulted to perform thorough neurological examinations on patients post-cardiac arrest and provide their expertise in treating and prognostication to guide the primary care providers and families in determining goals of care.

Summary Points

Jan 31, 2018 | Posted by in NEUROSURGERY | Comments Off on Hypoxic-Ischemic Injury After Cardiac Arrest
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