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The First national survey on Practices of Neurological Prognostication after Cardiac Arrest in China, still a lot to do
  • +11
  • lanfang du,
  • kang zheng,
  • lu feng,
  • yu Cao,
  • zhendong niu,
  • zhenju Song,
  • zhi Liu,
  • xiaowei Liu,
  • Xudong Xiang,
  • qidi Zhou,
  • hui Xiong,
  • fengying Chen,
  • guoqiang Zhang,
  • qingbian ma
lanfang du
Peking University Third Hospital
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kang zheng
Peking University Third Hospital
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lu feng
Peking University Third Hospital
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yu Cao
West China Hospital, Administration Building
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zhendong niu
West China Hospital
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zhenju Song
Zhongshan Hospital Fudan University
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zhi Liu
The First Affiliated Hospital of China Medical University
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xiaowei Liu
The First Affiliated Hospital of China Medical University
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Xudong Xiang
Second Xiangya Hospital, Central South University
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qidi Zhou
Peking University Shenzhen Hospital
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hui Xiong
Peking University First Hospital
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fengying Chen
The Affiliated Hospital of Inner Mongolia Medical University
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guoqiang Zhang
China-Japan Friendship Hospital
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qingbian ma
The Peking University Third Hospital
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Abstract

Aims: To investigate current practices and problems of neurological prognostication in comatose cardiac arrest (CA) patients. Methods: An anonymous questionnaire was distributed to 1600 emergency physicians in 75 hospitals which were selected randomly from China between January and July 2018. Results: 92.1% respondents fulfilled the survey. The details of the neurological prognosis were not well understood. The predictive value of brain stem reflex, motor response and myoclonus was confirmed by 63.5%, 44.6% and 31.7% respondents respectively. Only 30.7% knew that GWR value <1.1 indicated poor prognosis and only 8.1% know the most commonly used SSEP N20. Epileptiform, burst suppression, and isoelectric was considered to predict poor outcome by 35.0%, 27.4% and 45.7% respondents. 46.7% knew NSE, and only 24.7% knew S-100β. Only a few respondents knew that neurological prognostication should be performed later than 72h from CA either in TTM or non-TTM patients. In practice, the most commonly used method was clinical examination (85.4%). 67.9% had used brain CT for prognosis, and 18.4% for MRI. NSE (39.6%) was a little more widely used than S-100β (18.0%). However, SSEP (4.4%) and EEG (11.4%) were occasionally performed. The survey may have been subject to bias ascertainment as only university affiliated hospitals and university teaching hospitals were selected, making it likely that the degree of neuroprognostication awareness and practice reflected in our survey is an optimistic perspective. Conclusions: Neurological prognostication in CA survivors had not been well understood and performed by emergency physicians in China. They were more likely to use clinical examination rather than objective tools, especially SSEP and EEG, which also illustrated that multimodal approach was not well performed in practice.

Peer review status:IN REVISION

06 Jul 2020Submitted to International Journal of Clinical Practice
10 Jul 2020Submission Checks Completed
10 Jul 2020Assigned to Editor
11 Jul 2020Reviewer(s) Assigned
31 Jul 2020Review(s) Completed, Editorial Evaluation Pending
16 Sep 20201st Revision Received
16 Sep 2020Assigned to Editor
16 Sep 2020Reviewer(s) Assigned
16 Sep 2020Submission Checks Completed