Neurological prognostication after cardiac arrest

The care of the comatose cardiac arrest patient and his/her relatives in the ICU constitutes a major challenge for intensivists. Out-of-hospital cardiac arrest (OHCA) affects more than 275.000 Europeans yearly; survival rates are disturbingly low and have until recently remained unchanged [1]. During the last several years, significant efforts have been made to improve the quality of prehospital care, with a focus on more effective chest compressions. Postresuscitation care in the hospital was long ago identified as the "missing link" in the chain of survival, but a change in provision of care has occurred, as illustrated by the national Norwegian survey, published in the Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine [2]. Three years have passed since the telephone survey, but 80% of the hospitals in Norway had already introduced routine therapeutic hypothermia (TH) at that time. Today, almost every emergency hospital in all of Scandinavia routinely treats comatose cardiac arrest patients of cardiac origin with TH, and many have implemented a standardised treatment protocol as suggested [3].