Canadian Cardiovascular Society

The withdrawal of life-sustaining measures based on perceived poor neurologic prognosis due to underlying hypoxic-ischemic brain injury is the most common mechanism of death following successful resuscitation from cardiac arrest.

This is, in part, because determining neurologic function and prognosis is complex and standardized protocols have not been routinely implemented in practice. This CCS position statement aims to address this by proposing a systematic, multimodal approach for the post-cardiac arrest patient. 

“An important outcome of this Position Statement is creation of a protocol for neuroprognostication following out-of-hospital cardiac arrest using best available evidence and expert opinion,” says Christopher B. Fordyce MD MHS MSc FRCPC.

Read the 2023 Neuroprognostication PS for recommendations on: 

  1. circumstances immediately following CA;  
  2. focused neurologic exam;  
  3. myoclonus and seizures;  
  4. serum biomarkers;  
  5. neuroimaging;  
  6. neurophysiologic testing; and
  7. multi-modal neuroprognostication. 
Figure 1

“There is significant heterogeneity in the care of patients admitted to hospitals following out-of-hospital cardiac arrest (OHCA) with relatively few in-hospital interventions to treat this condition with a high risk of death on. Although many cardiovascular providers look after OHCA patients, the reality is that the majority of these patients die from neurological causes. The recommendations take into account not only the diagnostic tests themselves, but provide guidance in terms of the optimal timing when ordering these tests – in general, advocating for a more measured and delayed approach. By standardizing neuroprognostication, there is a potential opportunity to improve outcomes for OHCA patients.” says Fordyce. 

Interested in more content about Neuroprognostication? Visit the CJC Twitter account by clicking here to view the accompanying Tweetorials, launching April 6th and 20th, 2023

On behalf of the CCS, we recognize and thank Co-chairs Drs. Chris Fordyce and Andreas Kramer for their leadership, Dr. Emilie Belley- Côté for methods expertise and the full Neuroprognostication PS panel for their contribution and commitment to bring you these important recommendations. 

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