Neuroprognostication after cardiac arrest: what the cardiologist should know

Two aspects are a key to mastering prognostication of comatose cardiac arrest survivors: a detailed knowledge about the clinical trajectories of consciousness recovery (or lack thereof) and the ability to correctly interpret the results of multimodal investigations, which include clinical examination, electroencephalography, neuroimaging, evoked potentials, and blood biomarkers. While the very good and the very poor ends of the clinical spectrum typically do not pose diagnostic challenges, the intermediate 'grey zone' of post-cardiac arrest encephalopathy requires cautious interpretation of the available information and sufficiently long clinical observation. Late recovery of coma patients with initially ambiguous diagnostic results is increasingly reported, as are unresponsive patients with various forms of residual consciousness, including so-called cognitive motor dissociation, rendering prognostication of post-anoxic coma highly complex. The aim of this paper is to provide busy clinicians with a high-yield, concise overview of neuroprognostication after cardiac arrest, emphasizing notable developments in the field since 2020.

Automated summary

There are two key aspects to master the prognostication of comatose cardiac arrest survivors: a detailed understanding of the clinical trajectories of consciousness recovery and the ability to interpret the multimodal investigations accurately. The 'grey zone', which refers to the intermediate stage of post-cardiac arrest encephalopathy, requires cautious interpretation and prolonged clinical observation. Recent studies have shown late recovery in patients with initially ambiguous diagnostic results and unresponsive patients with residual consciousness, making the prognostication of post-anoxic coma highly complex. This paper aims to provide busy clinicians with a concise overview of neuroprognostication after cardiac arrest, highlighting the notable developments in the field since 2020.