Department of Neurology, Yale University School of Medicine, New Haven, CT.
Department of Neurology, UF-Health Shands Hospital, University of Florida College of Medicine, Gainesville, FL.
Crit Care Med. 2020 Feb;48(2):e107-e114. doi: 10.1097/CCM.0000000000004107.
To characterize approaches to neurologic outcome prediction by practitioners who assess prognosis in unconscious cardiac arrest individuals, and assess compliance to available guidelines.
International cross-sectional study.
We administered a web-based survey to members of Neurocritical Care Society, Society of Critical Care Medicine, and American Academy of Neurology who manage unconscious cardiac arrest patients to characterize practitioner demographics and current neuroprognostic practice patterns.
Physicians that are members of aforementioned societies who care for successfully resuscitated cardiac arrest individuals.
Not applicable.
A total of 762 physicians from 22 countries responses were obtained. A significant proportion of respondents used absent corneal reflexes (33.5%) and absent pupillary reflexes (36.2%) at 24 hours, which is earlier than the recommended 72 hours in the standard guidelines. Certain components of the neurologic examination may be overvalued, such as absent motor response or extensor posturing, which 87% of respondents considered being very or critically important prognostic indicators. Respondents continue to rely on myoclonic status epilepticus and neuroimaging, which were favored over median nerve somatosensory evoked potentials for prognostication, although the latter has been demonstrated to have a higher predictive value. Regarding definitive recommendations based on poor neurologic prognosis, most physicians seem to wait until the postarrest timepoints proposed by current guidelines, but up to 25% use premature time windows.
Neuroprognostic approaches to hypoxic-ischemic encephalopathy vary among physicians and are often not consistent with current guidelines. The overall inconsistency in approaches and deviation from evidence-based recommendations are concerning in this disease state where mortality is so integrally related to outcome prediction.
描述评估无意识心脏骤停个体预后的从业者在神经功能结局预测方面的方法，并评估其对现有指南的遵循情况。
国际横断面研究。
我们向神经重症监护学会、重症监护医学学会和美国神经病学学会的成员进行了一项基于网络的调查，这些成员管理无意识心脏骤停患者，以描述从业者的人口统计学特征和当前神经预后实践模式。
管理成功复苏的心脏骤停患者的上述学会的成员。
不适用。
从 22 个国家获得了 762 名医生的回复。相当一部分受访者在 24 小时时使用角膜反射消失（33.5%）和瞳孔反射消失（36.2%），早于标准指南推荐的 72 小时。神经检查的某些组成部分可能被高估，例如无运动反应或伸展性姿势，87%的受访者认为这些是非常或关键的预后指标。受访者继续依赖肌阵挛性癫痫持续状态和神经影像学，尽管后者已被证明具有更高的预测价值，但它们比正中神经体感诱发电位更受青睐。关于根据不良神经预后的明确建议，大多数医生似乎等到目前指南提出的postarrest 时间点，但高达 25%的医生使用过早的时间窗口。
在缺氧缺血性脑病的神经预后方法方面，医生之间存在差异，且通常与当前指南不一致。在这种死亡率与预后预测密切相关的疾病状态下，方法的整体不一致性和对基于证据的建议的偏离令人担忧。
