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Neuroprognostication After Cardiac Arrest — EECC MCQ

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ModerateGeneral CardiologyNeuroprognostication After Cardiac ArrestEECC

A 60-year-old man with known coronary artery disease and LVEF 35% is admitted following an out-of-hospital cardiac arrest. The initial rhythm was VF. He undergoes successful primary PCI to an acutely occluded RCA. He is haemodynamically stable post-procedure but remains unconscious. When should neuroprognostication be performed?

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Correct answer: C — Not before 72 hours after return to normothermia, using a multimodal approach combining clinical examination, EEG, somatosensory evoked potentials, neuroimaging, and biomarkers

Neuroprognostication after cardiac arrest should not be performed before 72 hours after return to normothermia (to allow clearance of sedative drugs and resolution of hypothermia effects). The ERC/ESICM 2021 guidelines recommend a multimodal approach combining: (1) clinical examination (absence of pupillary and corneal reflexes, bilateral absent N20 on SSEP, status myoclonus within 72h), (2) EEG (unreactive burst-suppression or suppressed background), (3) neuroimaging (CT/MRI showing diffuse cerebral oedema or widespread diffusion restriction), and (4) biomarkers (NSE >60 microg/L at 48-72h). No single test alone should determine prognosis. At least two independent poor-prognosis indicators should be present before withdrawal of life-sustaining treatment is considered.

Reference: ERC/ESICM (2021): Post-Resuscitation Care Guidelines