If motor response is flexion or better at any time, prognosis is indeterminate

• further neuroprognostication while in the ICU may not be beneficial

Any sign of definitive neurological improvement over the course of evaluation should prompt reconsideration of neurologic prognosis

TTM per institutional protocol or primary ICU team

Continuous EEG - treat electrographic status epilepticus if discovered

Document any clinical myoclonic status epilepticus

Consider NCHCT

Rewarming (per protocol or primary ICU team)

If there is absence of brainstem signs at any time ≥ 24 hours from ROSC, proceed to brain death evaluation

SSEP can be performed at t ≥ 48 hours if TTM was not pursued

NCHCT (consider MRI if patient is stable)

If both strong predictors are present, poor outcome is very likely

1. Absence of bilateral pupillary AND corneal reflexes

2. Absence of bilateral N20 waves on SSEP

If 1 strong predictor plus 1 moderate predictor OR 2 moderate predictors are present, poor outcome is likely

1. Myoclonic status epilepticus < 48 hours from ROSC

2. Unreactive EEG, burst suppression, or electrographic status epilepticus present

3. Diffuse anoxic injury on CT or MRI

If none of the above apply, prognosis is indeterminate

Following SSEP and assessment of reactivity, discontinue EEG if no seizures