2024 AANS Neurosurgical Topics for APPs - On-Demand-Neuroprognostication After Cardiac Arrest

Video Transcription

Video Summary

Dr. Sterling Shepard discusses neuroprognostication in comatose adult survivors post-cardiac arrest, using new 2023 guidelines. He reviews the statistics, highlighting that survival rates to discharge are low, but most discharged patients have favorable neurological outcomes. The guidelines emphasize a multimodal assessment approach, considering clinical exams, imaging, EEG, and historical medical data like initial cardiac rhythm and time to return of spontaneous circulation (ROSC). Key recommendations include deferring prognostication until at least three days post-ROSC for those not undergoing hypothermia treatment and extending observation for potential recovery. The guidelines urge avoiding reliance on single factors like pupil or corneal reflex absence alone, which can indicate poor outcomes. A critical update includes rejecting neuron-specific enolase as a definitive prognostic marker. The session concludes by stressing comprehensive care evaluations, including non-neurological health, preventive multimodal interventions, and early family involvement to align treatment with patient wishes, underscoring holistic prognostication over isolated symptom focus.

Keywords

neuroprognostication

cardiac arrest

2023 guidelines

multimodal assessment

prognostication timing

neuron-specific enolase

holistic care