Prognostication possibilities after hypoxic brain injury
For assessing the neurological prognosis the team of the Cardiac Arrest Center of Excellence uses a diagnostic pathway which is based on the data of
- the neurological examination results,
- electrophysiological examinations (SEP, EEG),
- biomarker of the hypoxic brain damage (neuron specific enolase, NSE).
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Prognostication after hypoxic brain injury
After introduction of TTM at the Charité the neurological outcome of our patients has significantly improved in comparison with a historical control group. We use for assessment of the neurological prognosis a diagnostic pathway which is based on the data of numerous, partly our own, current publications on this theme. The neurological examination results, electrophysiological examinations (SEP, EEG), biomarker of the hypoxic brain damage (neuron specific enolase, NSE) are all, and often repeatedly, ascertained.
Computed tomography of the brain is carried out in most patients. Because for patients after TTM the status of the data is still partially contradictory, patients who remain comatose with serious hypoxic brain damage undergo at least one-week intensive care therapy.
Only then is it discussed with the family the decision of withdrawal of treatment.
Exemplary clinical algorithm for assessment of prognosis after cardiac arrest and therapeutic hypothermia. The algorithm shows the current interdisciplinary consensus for the diagnostic and prognostic assessment of cardiac arrest survivors during the first days of treatment at the Charité – Universitätsmedizin Berlin. Established guidelines for prognosis of brain function after cardiac arrest (American Academy of Neurology and German Society of Neurology) are modified in accordance with the current state of research.