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Abstract Details

Variability in post-arrest prognosis knowledge by healthcare providers
Neuro Trauma, Critical Care, and Sports Neurology
P2 - Poster Session 2 (5:30 PM-6:30 PM)
4-073
<p scxw120595921"="">We studied variability among ICU providers involved in decision-making regarding post-cardiac arrest neurologic prognostication (PCANP).
TTM confounds traditional PCANP paradigms that have been used for decades.  Early withdrawal of life-sustaining therapy can prevent patients from achieving good long-term neurologic outcomes.  We are not aware of a study examining physician knowledge of PCANP since a recent guideline (Callaway CW, et al. 2015 Circulation).
ICU providers and neurology consultants at an academic medical center completed an online survey over a 6-week period. Questions dealt with specific history, physical exam and test results relevant to PCANP. 
<p scxw112547033"="">46 providers completed the survey (29% response rate), with 62% being neurologists or residents in internal medicine.  48% were NOT comfortable with PCANP methodology, and 58% were NOT satisfied with their PCANP training.  Tests ranked highest to lowest for importance for PCANP were: CT brain (38% chose as top choice); EEG; MRI brain; SSEP; neuron specific enolase (NSE, 8% chose as top choice).  History and physical exam elements ranked most to least important for PCANP were: resuscitation time (similar in importance to pupillary reflex); presence of early myoclonus; arrest rhythm; corneal reflex; limb motor response.   
<p scxw112547033"=""> When asked to choose when to assess patients for reliable physical exam results for PCANP, a substantial number of respondents chose answers that were 1-3 days earlier than suggested in the guideline. Of the respondents, this was 53% for pupillary reflex; 48% for corneal reflex; and 37% for the limb motor response. When asked for false positive rate (FPR) estimates in PCANP: a) 91% of respondents underestimated the NSE FPR substantially; b) 56% underestimated the limb motor response FPR substantially.
Significant misunderstanding of patient assessment in PCANP exists when compared to a recent guideline. Providers desire improved education and clinical tools for PCANP. 
Authors/Disclosures
Adarsh Menon
PRESENTER
No disclosure on file
No disclosure on file
Kiwon Lee, MD (RWJ University Hospital) No disclosure on file
No disclosure on file
No disclosure on file
Ram Mani, MD (Rutgers - Robert Wood Johnson Medical School) No disclosure on file