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Post-Cardiac Arrest Neuroprognostication — FRCA Final MCQ

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HardIntensive Care MedicinePost-Cardiac Arrest NeuroprognosticationFRCA Final

A 65-year-old man in ICU following cardiac arrest has a GCS of 3T (intubated). He was cooled to 36°C as per TTM2 guidance. On day 3, the following findings are present: bilaterally absent pupillary light reflexes, absent corneal reflexes, absent N20 cortical responses on somatosensory evoked potentials. According to the ERC/ESICM neuroprognostication guidelines, what can be concluded?

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Correct answer: B — EEG is required before any prognostication

The ERC/ESICM 2021 neuroprognostication algorithm recommends a multimodal approach to predicting poor neurological outcome after cardiac arrest. Bilaterally absent N20 cortical responses on SSEP at ≥72 hours post-ROSC is one of the most robust predictors of poor outcome (FPR <5%). Combined with absent pupillary and corneal reflexes at ≥72 hours AND no confounders (residual sedation, hypothermia, metabolic derangement), this pattern predicts poor outcome with high confidence. However, TWO or more concordant predictors are recommended before withdrawing life-sustaining treatment.

Reference: ERC/ESICM – 2021 – Post-resuscitation neuroprognostication; Resuscitation Council UK – 2021