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E.F.M. Wijdicks, MD, A. Hijdra, MD, G. B. Young, MD, C. L. Bassetti, MD and S. Wiebe, MD

From the Division of Critical Care Neurology (E.F.M.W.), Mayo Clinic College of Medicine, Rochester, MN; Department of Neurology (A.H.), Academic Medical Center, University of Amsterdam, The Netherlands; Department of Clinical Neurological Sciences (G.B.Y.), University of Western Ontario, London, Ontario, Canada; Department of Neurology (C.L.B.), University Hospital Zurich, Switzerland; Department of Clinical Neurosciences (S.W.), University of Calgary, Alberta, Canada.


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  		Figure. Decision algorithm for use in prognostication of comatose survivors after cardiopulmonary resuscitation. The numbers in the triangles are percentages. The numbers in parentheses are exact 95% CIs. Major confounders could include the use or prior use of sedatives or neuromuscular blocking agents, induced hypothermia therapy, presence of organ failure (e.g., acute renal or liver failure) or shock (e.g., cardiogenic shock requiring inotropes). Studies in comatose patients after CPR have not systematically addressed the impact of these factors on the reliability of clinical neurologic examination and tests. Therefore, these confounding factors potentially could diminish the prognostic accuracy of this algorithm. *These test results may not be available on a timely basis. Serum NSE testing may not be sufficiently standardized.