Prognostication After CA
1TBD, Thammasat University, Thailand
Combination of complex pathophysiologic process after resuscitated from cardiac arrest, known as post-cardiac arrest syndrome (PCAS), attribute to multiple organs damage. Global ischemic cascade occurs in the brain due to generalized and severe ischemia during cardiac arrest along with reperfusion process after return of spontaneous circulation (ROSC) leading to hypoxic / ischemic brain injury. This global brain injury is a major cause of death in patients with PCAS accounting for 68% of out-of hospital cardiac arrest (OHCA) and 23% of in-hospital cardiac arrest (IHCA). Targeted Temperature Management (TTM) is a well-known neuroprotective therapy for ischemic / hypoxic brain injury. The implementation of TTM for PCAS leads to reduction in mortality and better clinical outcomes among survivors. Prognostication is an important part of post-resuscitation care. Before TTM era, physicians relied on algorithm for prognostication in comatose patients released by American Academy of Neurology (AAN) in 2006. However, TTM also announced greater uncertainty into the method of prognostication. During this TTM era, prognostication should not be relied on just a solitary parameter. The trend of prognostication turns into a multimodal strategy integrating physical examination with supplementary methods, consisting of electrophysiology such as somatosensory evoked potential (SSEP) and electroencephalography (EEG), blood biomarkers particularly serum neuron specific enolase (NSE) , and neuro-radiography including brain imaging with CT / MRI and neurosonology such as transcranial Doppler (TCD), to enhance prognostic accuracy. The optimum time for prognostication using physical examination in PCAS patients treated with TTM, where many factors could be confounders, should be 72 hours after return to normothermia.