Following ROSC after cardiac arrest, the clinicians are responsible for determining the patient’s neurological status. The team must understand the assessments that will aid in developing a realistic prognosis for the patient. 

The team uses multiple modalities in this process:

Neuroprognostication Modalities

1. Clinical Assessment begins at the time of ROSC and continues throughout the patient’s stay. The assessments include:
   1. Targeted temperature management (TTM), beginning at ROSC and continuing for approximately 36 hours.
   2. After TTM, the team begins rewarming the patient. This process continues until 60 hours following ROSC.
   3. At that time, the team ensures normothermia and begins to reduce sedation
2. Radiological Assessment includes:
   1. CT of the head at the time of ROSC and as needed for 24 hours.
   2. After 24 hours, MRI is a better tool for predicting neurological outcomes.
3. Electrophysiological Assessment includes:
   1. Assessment of SSEP N20 cortical waves beginning at 24 hours after ROSC.
   2. Burst suppression and status epilepticus assessment beginning at 72 hours after ROSC.
4. Clinical Examination includes:
   1. Continual EEG assessment for status myoclonus beginning at 24 hours after ROSC.
   2. Assessment of pupillary light reflex, pupillometry, and corneal reflex beginning at 72 hours after ROSC.
5. Serum Biomarker Assessment includes assessment for serum neuron-specific enzyme (NSE) at 24 hours after ROSC.