Creating a Program for Neurologic Prognostication After Cardiac Arrest

Multimodal neurologic prognostication (MMNP) after cardiac arrest has been shown to enhance prognostic accuracy; however, it is vastly underused in real-world settings. Guideline-discordant practices and health care disparities in care after cardiac arrest have been reported widely. Process standardization may reduce practice variations and mitigate cognitive biases. We describe several steps taken at our institution to build robust systems of care and to ensure consistent, equitable MMNP. Our program is founded on multidisciplinary collaboration. A group of stakeholders worked to build and refine our protocols based on current guidelines and evidence, tailored to the institutional context and resources. Our partnership extends to the clinical space where patients are cared for by the critical care and neurology teams, leveraging the combined expertise of these disciplines. Regular didactics on neuroprognostication delivered to our trainees aim to emphasize the importance of performing a nuanced, multimodal assessment, accounting for clinical confounders (eg, sedation), acknowledging uncertainty, and allowing for sufficient time to prognosticate. We also leverage the electronic health record (EHR) to implement standardized order sets, documentation, and tools to facilitate consistency in care. Ongoing evaluation of processes is critical in recognizing and mitigating challenges while ensuring constant refinements of the infrastructure. In addition to optimizing prognostication itself, compassionate and transparent prognosis communication is a critical element of goal-concordant care. Regular review with key stakeholders and the clinical teams coupled with EHR-based data extraction allow for assessment of impact to ensure system optimization and sustainable growth.