SCCM Resource Library-The Latest in Neuroprognostication

Video Transcription

Video Summary

The webcast featured a detailed discussion on neuroprognostication in patients with traumatic brain injury (TBI), cardiac arrest, and the use of extracorporeal cardiopulmonary resuscitation (eCPR). Initial housekeeping notes mentioned that a recording would be available within five to seven business days on mysccm.org, and that interactive Q&A and polls would be featured throughout the presentation.<br /><br />Dr. Patrick Chen first discussed TBI, emphasizing the complexity and unpredictability in prognostication. He presented a case study of a young man with severe TBI who showed remarkable recovery, challenging the audience’s expectations and illustrating the need for cautious long-term prognosis, often extended beyond the intensive care phase. He highlighted the limitations of current prognostic tools like GCS, imaging, and clinical gestalt, showing they often don't adequately predict outcomes and can be overly pessimistic.<br /><br />Dr. Bhikata Krishna Rajaji discussed the updated guidelines on neuroprognostication following cardiac arrest. He emphasized the necessity of waiting at least 72 hours post-rewarming for accurate prognosis and highlighted the role of reliable predictors like bilateral non-reactive pupils and absent cortical responses in somatosensory evoked potentials. Moderately reliable predictors also include imaging and EEG. However, clinical gestalt and many commonly used variables such as age and initial cardiac rhythm are not reliable due to high false-positive rates.<br /><br />Dr. Alexis Steinberg examined prognostication in eCPR cases, arguing the importance of creating formal, evidence-based protocols for selecting patients for ECMO to avoid biases and disparities. She reviewed complications inherent in ECMO that affect neurological outcomes, acknowledging the complexity of accurate prognosis in these contexts given the interplay of multi-system organ failure and intensive sedation.<br /><br />Overall, the webcast urged a multi-modal approach to prognostication, taking into account the limitations and biases of current models and emphasizing the importance of individualized care and long-term observation. The session concluded with a Q&A addressing real-time prognostic challenges and reaffirming the need for ongoing research and thoughtful application of current guidelines.

Asset Subtitle

Neuroscience, 2024

Asset Caption

Review recent findings, updates, and new guidelines in neuroprognostication and learn how to incorporate them into clinical practice. This webcast explores challenging areas of focus in neuroprognostication, such as patients undergoing extracorporeal life support or extracorporeal membrane oxygenation, traumatic spinal cord injury, cardiac arrest, and/or traumatic brain injury.

Learning Objectives:
Discuss recent findings and updates in neuroprognostication for patients who have cardiac arrest
Discuss how to prognosticate for patients undergoing extracorporeal life support or extracorporeal membrane oxygenation
Explore how to prognosticate in patients with traumatic brain injury and/or traumatic spinal cord injury

Meta Tag

Content Type Webcast

Knowledge Area Neuroscience

Membership Level Professional

Membership Level Select

Tag Traumatic Brain Injury TBI

Tag Neurotrauma

Tag Spinal Cord Injury

Year 2024

Keywords

Webcast

Neuroscience

Traumatic Brain Injury TBI

Neurotrauma

Spinal Cord Injury

2024

Professional

Select

neuroprognostication

traumatic brain injury

cardiac arrest

eCPR

TBI recovery

prognostic tools

GCS limitations

bilateral non-reactive pupils

ECMO protocols

multi-modal approach

individualized care

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