Adult Neuroprognostication Following Cardiac Arrest and ROSC

Overview of Adult Neuroprognostication After Cardiac Arrest and ROSC

• Scope and Purpose: This guide, developed by The American National Red Cross (Copyright ©2025), is designed for healthcare professionals. It outlines testing modalities and specific findings used to predict an increased likelihood of a favorable (good) neurological outcome in adult patients who remain comatose following Return of Spontaneous Circulation (ROSC).

• Fundamental Clinical Principle: It is mandatory that no single test be used in isolation for the prediction of a good neurological outcome. Prognostication must be based on a comprehensive assessment of various modalities.

• Source Material Identification: This data is categorized as an "ALS 2025 REFERENCE CARD."

Key Terminology and Definitions

• ROSC: Return of Spontaneous Circulation.

• MRI: Magnetic Resonance Imaging.

• NSE: Neuron-specific enolase (a serum biomarker).

• Glasgow Coma Scale (GCS) Motor Score: A specific clinical metric used to evaluate the neurological motor response of the patient.

Prognostic Testing Categories and Favorable Findings

To identify an increased likelihood of a favorable neurological outcome, specific findings within the following categories are assessed:

• Clinical Findings:     * Glasgow Coma Scale Motor Score: Must be $> 3$.

• Brain Imaging:     * Magnetic Resonance Imaging (MRI): The absence of diffusion restriction is indicative of a better prognosis.

• Serum Biomarkers:     * Neuron-specific enolase (NSE): The NSE biomarker level should be within the normal range.     * Threshold for Normalcy: $< 17\,\text{mcg/liter}$.

• Electroencephalogram (EEG):     * Background Voltage: The EEG should show a continuous or nearly continuous normal voltage background.     * Exclusionary Criteria: The background must be free of periodic discharges or seizures.

Neuroprognostication Timeline After ROSC

The assessment of neurological outcomes occurs over a defined longitudinal timeline starting from the initial Return of Spontaneous Circulation. The critical assessment intervals include:

• ROSC (Initial Evaluation)

• $24\,\text{hours}$ post-ROSC

• $48\,\text{hours}$ post-ROSC

• $72\,\text{hours}$ post-ROSC

• $96\,\text{hours}$ post-ROSC

• $7\,\text{days}$ post-ROSC