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Neuroprognostication after cardiac arrest in the light of targeted temperature management

Oddo, Mauro and Friberg, Hans LU (2017) In Current Opinion in Critical Care 23(3). p.244-250
Abstract

PURPOSE OF REVIEW: Delayed awakening after targeted temperature management (TTM) and sedation is frequent among cardiac arrest patients. Differentiating between prolonged coma and irreversible cerebral damage can be challenging, therefore the utilization of a multimodal approach is recommended by international guidelines. Here, we discuss indications and advantages/disadvantages of available modalities for coma prognostication and describe new tools to improve our accuracy for outcome prediction. RECENT FINDINGS: Studies from the TTM era confirmed that combining neurological examination with electrophysiological assessment [electroencephalography (EEG) and somato-sensory evoked potentials (SSEP)] greatly improves coma prognostication.... (More)

PURPOSE OF REVIEW: Delayed awakening after targeted temperature management (TTM) and sedation is frequent among cardiac arrest patients. Differentiating between prolonged coma and irreversible cerebral damage can be challenging, therefore the utilization of a multimodal approach is recommended by international guidelines. Here, we discuss indications and advantages/disadvantages of available modalities for coma prognostication and describe new tools to improve our accuracy for outcome prediction. RECENT FINDINGS: Studies from the TTM era confirmed that combining neurological examination with electrophysiological assessment [electroencephalography (EEG) and somato-sensory evoked potentials (SSEP)] greatly improves coma prognostication. This combination is nowadays recognized as the most useful by many clinicians and appears widely applicable as part of initial patient assessment. Additional tests (serum neuron specific enolase and neuroimaging) may be most useful to orient clinical decisions in patients with prolonged coma. Advanced analysis of EEG and SSEP recordings and the emergence of quantitative pupillometry hold great promise. SUMMARY: Multimodal prognostication offers a comprehensive approach of anoxic–ischemic encephalopathy and is increasingly used in postresuscitation care. Worldwide implementation and future advancements of available modalities, together with the increasing use of novel automated devices for quantitative neurological examination, may further optimize prognostic accuracy in the early ICU phase following cardiac arrest.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
cardiac arrest, Neuroprognostication, temperature management
in
Current Opinion in Critical Care
volume
23
issue
3
pages
244 - 250
publisher
Lippincott Williams & Wilkins
external identifiers
  • scopus:85015722517
  • pmid:28323720
  • wos:000401296500012
ISSN
1070-5295
DOI
10.1097/MCC.0000000000000406
language
English
LU publication?
yes
id
7f5c6693-a11b-4bc8-971c-2f80e1816c7b
date added to LUP
2017-04-23 13:40:28
date last changed
2018-01-07 12:00:26
@article{7f5c6693-a11b-4bc8-971c-2f80e1816c7b,
  abstract     = {<p>PURPOSE OF REVIEW: Delayed awakening after targeted temperature management (TTM) and sedation is frequent among cardiac arrest patients. Differentiating between prolonged coma and irreversible cerebral damage can be challenging, therefore the utilization of a multimodal approach is recommended by international guidelines. Here, we discuss indications and advantages/disadvantages of available modalities for coma prognostication and describe new tools to improve our accuracy for outcome prediction. RECENT FINDINGS: Studies from the TTM era confirmed that combining neurological examination with electrophysiological assessment [electroencephalography (EEG) and somato-sensory evoked potentials (SSEP)] greatly improves coma prognostication. This combination is nowadays recognized as the most useful by many clinicians and appears widely applicable as part of initial patient assessment. Additional tests (serum neuron specific enolase and neuroimaging) may be most useful to orient clinical decisions in patients with prolonged coma. Advanced analysis of EEG and SSEP recordings and the emergence of quantitative pupillometry hold great promise. SUMMARY: Multimodal prognostication offers a comprehensive approach of anoxic–ischemic encephalopathy and is increasingly used in postresuscitation care. Worldwide implementation and future advancements of available modalities, together with the increasing use of novel automated devices for quantitative neurological examination, may further optimize prognostic accuracy in the early ICU phase following cardiac arrest.</p>},
  author       = {Oddo, Mauro and Friberg, Hans},
  issn         = {1070-5295},
  keyword      = {cardiac arrest,Neuroprognostication,temperature management  },
  language     = {eng},
  month        = {03},
  number       = {3},
  pages        = {244--250},
  publisher    = {Lippincott Williams & Wilkins},
  series       = {Current Opinion in Critical Care},
  title        = {Neuroprognostication after cardiac arrest in the light of targeted temperature management},
  url          = {http://dx.doi.org/10.1097/MCC.0000000000000406},
  volume       = {23},
  year         = {2017},
}