The other main question that came up during Kevin’s morning report was how hypothermia affects prognostication after cardiac arrest. The recent Continuum issue on Critical Care Neurology has an article on this very topic, and I highly recommend that everyone read it. Such prognostication is a major responsibility for the consulting neurologist, and more and more patients are being treated with hypothermia. Take home points:
- Whereas an absent pupillary response at 72 hours remains predictive of poor outcome even after hypothermia, an absent corneal response has a false positive rate of 5%. (The paper showing that was written by our very own Edgar Samaniego).
- Absent or extensor motor responses at 72 hours does not reliably predict poor outcome.
- Myoclonus status epilepticus does appear to be reliable in predicting poor outcome after post-arrest hypothermia.
(In the 2006 AAN Practice Parameter, poor outcome was defined as “1) death or persisting unconsciousness after 1 month or 2) death, persisting unconsciousness, or severe disability requiring full nursing care after 6 months”).