Patients who suffered cardiac arrest have improved neurologic outcomes with TH. The initial neurologic exam is an important element for prognostication of favorable outcomes.  

Patients who suffered cardiac arrest have improved neurologic outcomes with TH. The initial neurologic exam is an important element for prognostication of favorable outcomes.  

A retrospective chart review was conducted on all TH patients at a tertiary care hospital in Newark, NJ from August 2012 to August 2017. As part of the TH protocol, we assessed brainstem reflexes in all patients before initiation of TH. Positive predictive value (PPV) and negative predictive value (NPV) were calculated for pupillary, corneal, vestibular-ocular and gag reflexes individually as well as all combined.   

98 patients (59 % men, 41% women, mean age 55±14.8) were analyzed. 31.6% (n=31) of patients survived and 68.4% (n=67) died. Of those who survived, 68% had pupillary reflex, 68% had corneal reflex, 42% had vestibular-ocular reflex (VOR) and 71% had gag reflex on initial examination. Among the patients who died, 34% had pupillary reflex, 27% had corneal reflex, 9% had VOR, 19% had gag reflex on initial examination. The PPV of pupillary reflex is 49%, corneal reflex 54%, VOR 68% and gag reflex 63%. The PPV for all reflexes combined is 67%. The NPV of pupillary reflex is 81%, corneal reflex 83%, VOR 76% and gag reflex 88%. The NPV of all reflexes combined is 97%. 

Early neurological examination prior to initiation of the TH can help determine whether a patient will have a favorable outcome with TH. Absence of all four brainstem reflexes is highly associated with non-survivable outcome.