ICU · Neurocritical care / post-arrest

Neuro-Prognostication After Cardiac Arrest — The 72-Hour Multimodal Rule

Also known as Neuro-prognostication · Post-anoxic coma · Post-cardiac-arrest prognostication · Anoxic brain injury · 72-hour rule · Somatosensory evoked potentials · SSEP · N20 · NSE · Self-fulfilling prophecy · TTM2 · Multimodal prognostication · ERC/ESICM

The neuro-prognostication after a cardiac arrest is deferred until at least 72 hours after the return of the spontaneous circulation, with the patient normothermic and off the sedation. The principle is the MULTIMODAL assessment — no single predictor determines the prognosis, because the falsely pessimistic prediction creates the self-fulfilling prophecy (the early withdrawal of the care). The predictors (examined together): the absent brainstem reflexes (the pupillary, the corneal), the absent motor response to pain, the bilateral absent N20 on the somatosensory evoked potentials (the most reliable single test), the highly malignant EEG patterns (suppression with periodic discharges, burst-suppression), the elevated neuron-specific enolase, and the MRI diffusion anoxic pattern. The TTM tri…