Top Things to Know: Standards for Studies of Neurological Prognostication in Comatose Survivors of Cardiac Arrest
Published: July 11, 2019
- Accurate prognostication is important to avoid pursuing futile treatments when poor outcome is inevitable but also to avoid an inappropriate withdrawal of life-sustaining treatment in patients who may otherwise have a chance of achieving meaningful neurological recovery.
- Inaccurate neurological prognostication leading to withdrawal of life-sustaining treatment and deaths may significantly bias clinical studies, leading to failure in detecting the true study outcomes.
- The purpose of this statement is to provide suggestions for multiple levels of study design, execution, and interpretation of tests.
- This statement elaborated on assessing brain injury and subsequent prognosis after cardiac arrest.
- Focus on the design of neurological prognostication studies including predictive tests as categorical or continuous variables, precision, multivariate models, current measures of neurological outcomes, and dichotomization of neurological outcome measures
- Neurological prognostication studies must consider the timing of various assessments and observations.
- Prearrest and intra-arrest factors and variables are also important considerations for neurological prognostication studies.
- Elaborates on the importance of postarrest evaluation and the postarrest variables after cardiac arrest.
- A major cause of death in cardiac arrest survivors is related to withdrawal of life support, which is heavily dependent on neurological prognostication. With the low quality of existing neurological prognostication studies, errors are more likely.
- The suggestions provided will contribute to improvements in the quality of neurological prognostication studies, which will, in turn, improve the quality of care provided and affect clinical outcomes and the conduct of clinical investigations in this area.
Citation
Geocadin RG, Callaway CW, Fink EL, Golan E, Greer DM, Ko NU, Lang E, Licht DJ, Marino BS, McNair ND, Peberdy MA, Perman SM, Sims DB, Soar J, Sandroni C, on behalf of the American Heart Association Emergency Cardiovascular Care Committee. Standards for studies of neurological prognostication in comatose survivors of cardiac arrest: a scientific statement from the American Heart Association [published online ahead of print July 11, 2019]. Circulation. doi: 10.1161/CIR.0000000000000702.