Neurological Prognostication after Cardiac Arrest: Survey on Current Practices in Saudi Arabia

Objectives: Although the prognosis for comatose survivors of cardiac arrest (CA) is extremely poor, recently published evidence suggests that a small percentage of patients who have premature withdrawal of life-support therapy (WLST) might have regained some level of consciousness if LST had been continued. When and how to perform neuroprognostication evaluations to limit such instances has become of considerable interest. Methods: We performed a country-wide, online survey of members of the Saudi Critical Care Society (SCCS) in Saudi Arabia to identify current perspectives pertaining to neuroprognostication and WLST in comatose CA survivors, mirroring the methods of an international survey conducted in 2012 and published in 2015. We then compared our results against that survey’s findings and currently published guidelines. Results: Fifty-three of 266 SCCS members (20%) completed surveys. Major differences between our and 2012 results were the relative nonuse of induced hypothermia, strict use of physician versus nursing assessments of neurological status, and reduced acceptance of WLST in contemporary Saudi Arabia. Areas of agreement included adopting a multimodal approach to neuroprognostication; waiting near or beyond 72 h after CA to initiate neuroprognostication; and performing neurological exams at least daily. These areas of agreement largely coincide with recently published guidelines. Conclusions: Considerable controversy persists in neuroprognostication and WLST practices, and current guidelines largely rely on low-to intermediate-quality evidence. Extensive further research is necessary to prevent both the unnecessary prolongation of life when no hope of recovery exists, and premature termination of life when it still might.