Discuss your approach to prognostication of neurological outcome in adult ICU patients after successful cardiovascular resuscitation following out of hospital cardiac arrest. Your answer should include the following headings:
a) Guidelines. (2 marks)
b) General approach and clinical factors. (3 marks)
c) Investigations, and their role in prognostication. (5 marks)
Syllabus topic/section:
2.1.8 Neurological Intensive Care / Hypoxic Ischaemic Encephalopathy: L1
Discussion:
Candidates demonstrated the standard required if they addressed their answer as per the 3 parts of the question, showed a clearly thought-out process of neuroprognostication and acknowledged a multi-modal approach with repeated examination and appropriate timing.
Candidates who were not familiar with any guidelines or able to reference them and/or were unclear regarding clinical features, relevant investigations and timing of neuroprognostication indicators did not demonstrate the standard required and marks were allocated accordingly.
|
Below standard |
At standard |
Above standard |
|
|
Guidelines |
Specific mention of >=1 relevant guideline (NCCS, ILCOR or ESICM), but not linked to rest of the answer |
Specific reference to >=1 relevant guideline, including how it informs the answer |
As per standard AND some critical discussion |
|
(2 marks) |
0-0.5 marks |
1.0 mark |
1.5-2.0 marks |
|
General approach and clinical factors |
Poorly structured with minimal discussion about general approach; omits timing of assessment; or does not acknowledge prognostic uncertainty |
Appropriate structure. Includes timing, AND integration of multiple parameters OR Favourable + Poor indicators |
Includes Timing AND Integration of multiple parameters AND favourable + poor indicators AND Prognostic uncertainty / Values-based care |
|
(3 marks) |
0-1.0 marks |
1.5-2.0 marks |
2.5-3.0 marks |
|
Investigations and role in prognostication |
Incomplete list of basic investigations (CT, MRI, electrophysiology [EEG and/or N20], and laboratory investigations) or minimal description of basic interpretation of chosen investigations |
Complete list as per below standard and description of key prognostic features of each investigation |
As per standard with detailed description including timing, reliability and controversies |
|
(5 marks) |
0-2.0 marks |
2.5-3.5 marks |
4.0-5.0 marks |
a) Guidelines:
b)
General approach:
Clinical features associated with a poor outcome:
c)
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