Prognostication in comatose survivors of cardiac arrest

Prognostication in comatose survivors of cardiac arrest: are the new guidelines a breakthrough?

Bernd W. Böttiger: I do expect that the new guidelines are really a breakthrough. In the past, all these decisions were made on a very individual basis, and the fear is that at least in some patients therapy was stopped too early despite the fact that they would have had a good chance of good neurological recovery and survival.

In the new guidelines, we came up with a totally new approach on prognostication. The most important message is that it is not recommended to do any prognostication before 72 hours, or not before 3 days, after return of spontaneous circulation. After 3 days, pupillary and corneal reflexes may be used, and also somatosensory evoked potentials, but if there is no clear signal coming with these investigations, one should wait at least another 24 hours, meaning overall 96 hours after return of spontaneous circulation, to use any other types of investigations. And if we are using any other types of investigations, like biomarkers or electroencephalogram or CT scanning, combination of these things is strongly recommended, because all these measures do not have very high levels of sensitivity and specificity.

So there is a revolution in prognostication with the new guidelines. Do not do it before 72 hours and maybe you will have to wait until 96 hours after return of spontaneous circulation.