Better science needed to support clinical predictors that link cardiac arrest, brain injury, and death: a statement from the American Heart Association

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According to new research in the American Heart Association’s journal Circulation, resuscitation and post-resuscitation care after cardiac arrest have both improved but mortality remains high. Most of the poor outcomes and deaths of cardiac arrest survivors have been attributed to widespread brain injury, but inaccurate neurologic prognostication, resulting in withdrawal of life-sustaining treatment and deaths, may significantly bias clinical studies, leading to failure in detecting the true study outcomes.

The vast majority of patients who are successfully resuscitated from cardiac arrest are diagnosed after their resuscitation with coma or with an altered level of consciousness due to lack of oxygen to the brain before resuscitation. Most deaths associated with brain injury after cardiac arrest result from active withdrawal of life-sustaining treatment because a poor neurologic outcome is predicted. While most deaths in patients initially resuscitated from cardiac arrest are attributed to brain injury, only about 10% of these deaths meet clinical criteria for brain death.

Determining prognosis after successful resuscitation is a central component of post-cardiac arrest care. Unfortunately, the quality of science that supports prediction of outcome in comatose survivors of cardiac arrest is low. This low quality of science leads to error in predictions of outcomes that are likely to have a negative impact on patient care and clinical trials.

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