Orv Hetil. 2026 Nov 8;167(45):1799-1809. doi: 10.1556/650.2026.33659. Print 2026 Nov 8.

ABSTRACT

Post-cardiac arrest brain injury represents a central component of the post-resuscitation syndrome, driven not only by the initial hypoxic-ischemic insult but also by reperfusion injury after the return or start of mechanical circulation. Complex neuronal damage accounts for a substantial proportion of mortality among successfully resuscitated patients, making reliable neurological prognostication a key objective of post-resuscitation care and clinical decision-making. The 2025 European Resuscitation Council guidelines emphasize a structured, multimodal approach to neuroprognostication. Prognosis should not rely on a single parameter; instead, it requires the integrated interpretation of clinical findings, electrophysiological data, neuroimaging results, and circulating biomarkers. This strategy aims to reduce falsely pessimistic predictions, prevent premature withdrawal of life-sustaining therapy, and avoid the unnecessary prolongation of futile intensive care in cases of irreversible brain injury. In the early phase of return of spontaneous circulation, neurological assessment may be confounded by several factors, including residual sedation, neuromuscular blockade, metabolic disturbances, and cardiorespiratory instability. Therefore, accurate prognostication depends on the correction of reversible conditions and stabilization of physiological parameters before definitive conclusions are drawn. Importantly, neurological outcome assessment is inherently time-dependent, and appropriate timing is essential for safe and evidence-based decision-making. Overall, the 2025 recommendations advocate standardized, multidisciplinary, and stepwise neuroprognostication as a cornerstone of post-resuscitation management, prioritizing patient-centered care while minimizing uncertainty and supporting long-term neurological recovery whenever possible. Orv Hetil. 2026; 167(45): 1799-1809.

PMID:42999955 | DOI:10.1556/650.2026.33659