Post-resuscitation care: ERC/ESICM updated Guidelines - Page 4
Concerning Neurophysiology, they recommend,
- “Perform an EEG in patients who are unconscious after the arrest.
- Highly malignant EEG-patterns include suppressed background with or without periodic discharges and burst-suppression. We suggest using these EEG-patterns after the end of TTM and after sedation has been cleared as indicators of a poor prognosis.
- The presence of unequivocal seizures on EEG during the first 72 h after ROSC is an indicator of a poor prognosis.
- Absence of background reactivity on EEG is an indicator of poor prognosis after cardiac arrest.
- Bilateral absence of somatosensory evoked cortical N20-potentials is an indicator of poor prognosis after cardiac arrest.
- Always consider the results of EEG and somatosensory evoked potentials (SSEP) in the context of clinical examination findings and other tests. Always consider using a neuromuscular blocking drug when performing SSEP.”
For Biomarkers, they recommend, “Use serial measurements of NSE in combination with other methods to predict outcome after cardiac arrest. Increasing values between 24 and 48 h or 72 h in combination with high values at 48 and 72 h indicates a poor prognosis”.
Regarding Imaging, they recommend to,
- “Use brain imaging studies for predicting poor neurological outcome after cardiac arrest in combination with other predictors, in centres where specific experience in these studies is available.
- Use presence of generalised brain oedema, manifested by a marked reduction of the grey matter/white matter ratio on brain CT, or extensive diffusion restriction on brain MRI to predict poor neurological outcome after cardiac arrest.
- Always consider findings from imaging in combination with other methods for neurological prognostication.”
With regard to WITHDRAWAL OF LIFE-SUSTAINING THERAPY, they recommend,
- “Separate discussions around withdrawal of life-sustaining therapy (WLST) and the assessment of prognosis for neurological recovery; WLST decisions should consider aspects other than brain injury such as age, co-morbidity, general organ function and the patients’ preferences.
Allocate sufficient time for communication around the level-of-treatment decision within the team and with the relatives.”
- Organise follow-up for all cardiac arrest survivors within 3 months after hospital discharge, including the following:
1. Screening for cognitive problems.
2.Screening for emotional problems and fatigue.
3.Providing information and support for survivors and family members.”
For ORGAN DONATION, they recommend,
“All decisions concerning organ donation must follow local legal and ethical requirements.
Organ donation should be considered in those who have achieved ROSC and who fulfil neurological criteria for death.
In comatose ventilated patients who do not fulfil neurological criteria for death, if a decision to start end-of-life care and withdrawal of life support is made, organ donation should be considered for when circulatory arrest occurs.”
Concerning, CARDIAC ARREST CENTERS, they recommend, “Adult patients with non-traumatic OHCA should be considered for transport to a cardiac arrest centre according to local protocol.”
For further information:
https://link.springer.com/article/10.1007/s00134-021-06368-4
Article Source : Intensive Care Medicine
