TY - JOUR
T1 - A structured approach to neurologic prognostication in clinical cardiac arrest trials
AU - Cronberg, Tobias
AU - Horn, Janneke
AU - Kuiper, Michael A.
AU - Friberg, Hans
AU - Nielsen, Niklas
PY - 2013
Y1 - 2013
N2 - Brain injury is the dominant cause of death for cardiac arrest patients who are admitted to an intensive care unit, and the majority of patients die after withdrawal of life sustaining therapy (WLST) based on a presumed poor neurologic outcome. Mild induced hypothermia was found to decrease the reliability of several methods for neurological prognostication. Algorithms for prediction of outcome, that were developed before the introduction of mild hypothermia after cardiac arrest, may have affected the results of studies with hypothermia-treated patients. In previous trials on neuroprotection after cardiac arrest, including the pivotal hypothermia trials, the methods for prognostication and the reasons for WLST were not reported and may have had an effect on outcome. In the Target Temperature Management trial, in which 950 cardiac arrest patients have been randomized to treatment at 33[degree sign]C or 36[degree sign]C, neuroprognostication and WLST-decisions are strictly protocolized and registered. Prognostication is delayed to at least 72 hours after the end of the intervention period, thus a minimum of 4.5 days after the cardiac arrest, and is based on multiple parameters to account for the possible effects of hypothermia
AB - Brain injury is the dominant cause of death for cardiac arrest patients who are admitted to an intensive care unit, and the majority of patients die after withdrawal of life sustaining therapy (WLST) based on a presumed poor neurologic outcome. Mild induced hypothermia was found to decrease the reliability of several methods for neurological prognostication. Algorithms for prediction of outcome, that were developed before the introduction of mild hypothermia after cardiac arrest, may have affected the results of studies with hypothermia-treated patients. In previous trials on neuroprotection after cardiac arrest, including the pivotal hypothermia trials, the methods for prognostication and the reasons for WLST were not reported and may have had an effect on outcome. In the Target Temperature Management trial, in which 950 cardiac arrest patients have been randomized to treatment at 33[degree sign]C or 36[degree sign]C, neuroprognostication and WLST-decisions are strictly protocolized and registered. Prognostication is delayed to at least 72 hours after the end of the intervention period, thus a minimum of 4.5 days after the cardiac arrest, and is based on multiple parameters to account for the possible effects of hypothermia
U2 - https://doi.org/10.1186/1757-7241-21-45
DO - https://doi.org/10.1186/1757-7241-21-45
M3 - Review article
C2 - 23759121
SN - 1757-7241
VL - 21
SP - 45
JO - Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
JF - Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
IS - 1
ER -