Predictors of Neurological Disability After Cardiac Arrest

Abstract As an emergency medicine provider, I am faced with resuscitating patients after out of the hospital cardiac arrest. The most difficult challenge after resuscitation is predicting the neurologic disability if any in the days following the arrest. The decision to continue to code someone after they arrive in the emergency department after an out of hospital cardiac arrest (OHCA) depends on many factors. These factors include how long someone has been down and if there is any sign of neurologic function on the initial assessment. Predictors of neurologic function after a cardiac arrest include gag reflex, ocular reflexes, somatosensory evoked potentials, and serum biomarkers.¹ Prognostication after cardiac arrest is challenging especially in the patient that has been treated with hypothermia, muscle relaxants, and sedatives. There has been no single test that can predict a poor prognosis with absolute certainty.² As medicine continues to evolve and new therapeutic interventions are put in place the predictive value of once reliable neurological function assessments such as electroencephalography, somatosensory-evoked potentials, biomarkers, and radiological imaging should now be used with a standard neurological examination in a multimodal approach for predictability.³ A standard neurological examination was the only tool available for clinicians to predict the neurological outcome following OHCA for many years. The Gold Standard has been the Glasgow Coma Scale (GCS) and there have been many attempts to replace this with an even more reliable and simple neurological assessment.⁴ This paper will review the current neurological assessment tools and compare them in efforts to inform the provider which modalities are the most accurate and easy to use in predicting neurological outcomes