Sedation, hypothermia, metabolic disturbance and organ failure all depress neurological examination in the first days after resuscitation. Decisions based on an early examination alone risk withdrawing care from patients who would have recovered.
Current practice is to delay formal prognostication until at least 72 hours after return of circulation, once sedation has cleared, and to combine several tests rather than rely on any single one.
- Wait at least 72 hours after return of spontaneous circulation before formal neurological prognostication.
- Exclude residual sedation, hypothermia and severe metabolic derangement before examining.
- Combine examination, imaging, EEG and, where available, biomarkers; no single test is enough.
- Record the reasoning and share uncertainty with the family plainly.
Why it matters
Premature prognosis can turn an uncertain outcome into a self-fulfilling one.
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