Prognostication following Cardiac Arrest and Brain Stem Death

Authors: Shashank Patil, Saqib Parwez / Editors: Kris Moothian Pillay,  Michael Perry / Reviewer: Rebecca Ford / Code:  / Published: 16/09/2022

In United Kingdom, approximately 76,000 patients per year sustain Cardiac Arrest following a non-traumatic cause in an inpatients and out-of-hospital settings. This is associated with high mortality, but a considerable proportion of those who survive the event have a poor neurological recovery.

The Chain of Survival conceptualises the important components of successful resuscitation. This is achieved by development, implementation and standardisation of national guidelines and treatment protocols. The links in the chain need to be strengthened by research, community programmes and raising awareness. This will automatically improve the survival to discharge.

These medical interventions are associated with excessive costs and the current evidence shows varied outcomes. This also has a significant impact on family members financially and emotionally.

It is, therefore, imperative for the medical professionals who are involved in delivering this care, have a strategy, tools to recognise and prognosticate the outcome in these patients.

There are several factors prior, during and post cardiac arrest which can influence the outcome of cardiac arrest. The prognostication strategy follows some key principles; Early communication, Delay timing of prognostication, Multimodal evaluation and Being patient.

The medical professionals have a great responsibility of ensuring the survivals of Cardiac Arrest have an excellent quality of life.

Learning Objectives:

  • Current Prevalence of Cardiac Arrest
  • Concept of Chain of Survival
  • Factors influencing survival to hospital discharge
  • Principles of Prognostication Strategy
  • Multimodal evaluation technique
  • Brain Stem Death


  1. Perkins GD, Brace-McDonnell SJ On behalf of the OHCAO Project Group. The UK Out of Hospital Cardiac Arrest Outcome (OHCAO) project. BMJ Open 2015;5:e008736. doi: 10.1136/bmjopen-2015-008736.
  2. Petrie J, Easton, S, et al. Hospital costs of out-of-hospital cardiac arrest patients treated in intensive care; a single centre evaluation using the national tariff-based system. BMJ Open 2015;5:e005797. doi:10.1136/bmjopen-2014-005797
  3. ICNARC. Key NCAA statistics.
  4. Resuscitation Council UK. Consensus Paper on out-of-hospital cardiac arrest in England.
  5. Geocadin RG, Wijdicks EF, Armstrong MJ, et al. Practice guideline summary: Reducing brain injury following cardiopulmonary resuscitation Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology. Neurology 2017; 88:2141-2149.
  6. Sandroni C, Nolan JP. Neuroprognostication after cardiac arrest in Europe: new timings and standards. Resuscitation. 2015 May;90:A4-5.
  7. Petrie J, Easton S, Naik V, et al. Hospital costs of out-of-hospital cardiac arrest patients treated in intensive care; a single centre evaluation using the national tariff-based system. BMJ Open. 2015;5:e005797.
  8. Eveson L, Vizcaychipi M, Patil S. Role of Bispectral index monitoring and burst suppression in prognostication following out-of-hospital cardiac arrest: a systematic review protocol. Systematic Reviews 2017 (6):191
  9. Resuscitation Council, UK. Resuscitation to Recovery: A national framework to improve care of people with out-of-hospital cardiac arrest in England. March 2017.
  10. Farag M, Patil S. Prognostication following out-of-hospital cardiac arrest. ICU Management & Practice 2017; 2:22-24.
  11. Sandroni C, Cariou A, Cavallaro F, et al. Prognostication in comatose survivors of cardiac arrest: an advisory statement from the European Resuscitation Council and the European Society of Intensive Care Medicine. Intensive Care Med. 2014 Dec;40(12):1816-31.
  12. Tsou PY, Kurbedin J, Chen YS, et al. Accuracy of point-of-care focused echocardiography in predicting outcome of resuscitation in cardiac arrest patients: A systematic review and meta-analysis. Resuscitation. 2017 May;114:92-99.
  13. Academy of Medical Royal Colleges. A Code of Practice for the Diagnosis and Confirmation of Death. 2008.

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