Abstract Details

Title Underutilization of a Post-Cardiac Arrest Consult Service for Standardization of a Guideline-Based Multimodal Neuroprognostication Algorithm in Comatose Cardiac Arrest Survivors

Topic Neuro Trauma, Critical Care, and Sports Neurology

Presentation(s) Neurocritical Care Posters (7:00 AM-5:00 PM)

Poster/Presentation
Number 012

Objective

To estimate the utilization rates of a dedicated post-cardiac arrest consult service (PCACS) and individual components of a guideline-based neuroprognostication checklist in comatose survivors of cardiac arrest (CA).

Background Several CA survivors remain comatose after successful cardiopulmonary resuscitation. Recent guidelines recommend a standardized multimodal neuroprognostication scheme to prevent inappropriate withdrawal of life-sustaining treatment (WLST) and improve family satisfaction.

Design/Methods Consecutive patients admitted to intensive care units with a diagnosis of CA between July 2018 and June 2019 were included. Patients who died within 48 hours of CA, required Extracorporeal Membrane Oxygenation, or followed commands within 24 hours of CA were excluded. We calculated the total proportion of PCACS consults and compared utilization rates of individual elements of the prognostication checklist [i.e. pupillary exam off sedation, electroencephalography (EEG), computed tomography (CT) or magnetic resonance imaging (MRI), neuron-specific enolase (NSE), and somatosensory evoked potential (SSEP)] between patients who did and did not receive PCACS. Fisher's exact tests were used for statistical comparisons.

Results

Of the total 216 CA cases, 121 were eligible for the study (60% male; mean age 63±16.3). A PCACS was called for 66% (n = 80) of patients. Compared to patients who had a PCACS called, patients without PCACS demonstrated significantly lower utilization rates of the pupillary exam (94% vs 41%; p<0.001), EEG (82% vs 12%; p<0.001), CT or MRI (74% vs 27%, p<0.001), NSE (78% vs 5%; p<0.001), and SSEP (24% vs 0%; p=0.025) for neuroprognostication.

Conclusions A substantial proportion of eligible comatose survivors of cardiac arrest did not receive PCACS or recommended neuroprognostication. Despite overall low uptake, a dedicated PCACS was associated with increased utilization of a multimodal prognostication algorithm in this patient population. Future studies utilizing mixed-methods should look into the effectiveness, barriers, and facilitators of implementing such a service.

Authors/Disclosures
Wendy Tong PRESENTER	Ms. Tong has nothing to disclose.
Greer Waldrop, MD (UCSF)	Dr. Waldrop has nothing to disclose.
Kiran Thakur, MD, FAAN (Columbia University College of Physicians and Surgeons)	Dr. Thakur has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Delve Bio. The institution of Dr. Thakur has received research support from Center for Disease Control and Prevention.
David J. Roh, MD (Columbia University Medical Center)	Dr. Roh has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Portola Pharmaceuticals.
Soojin Park, MD	Dr. Park has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Neurocritical Care. The institution of Dr. Park has received research support from National Institutes of Health.
Jan Claassen, MD, PhD (Columbia University College of Physicians & Surgeons)	Dr. Claassen has stock in iCE Neurosystems. The institution of Dr. Claassen has received research support from NINDS. The institution of Dr. Claassen has received research support from McDonnel Foundation. Dr. Claassen has received publishing royalties from a publication relating to health care. Dr. Claassen has received publishing royalties from a publication relating to health care.
Sachin Agarwal, MD, MPH (Columbia University Med Center)	Dr. Agarwal has nothing to disclose.

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