To determine if a specialized neuroprognostication program improves guideline-adherence, outcomes, and hospital length of stay (LOS). 

The withdrawal of life-sustaining treatment for a poor neurologic prognosis is the most common cause of death in survivors of cardiac arrest. However, neuroprognostication is conducted variably, inconsistently adheres to guidelines, and is prone to error. We implemented a novel neuroprognostication program that provides specialized inpatient consultations, hypothesizing an associated improvement in guideline-adherence, outcomes, and LOS. 

We abstracted neuroprognostication testing, outcomes, and LOS for consecutive out-of-hospital cardiac arrest patients admitted unconscious (without command-following) to our health system (both intervention and non-intervention hospitals) in the years prior to program implementation (pre; 2019-2022) and after (post; 2022-2024). For guideline-compliance, we reviewed post-arrest neuroprognostication guidelines and identified tests endorsed by all (EEG, CT, MRI, SSEP, and pupillary responses). For outcomes, we measured the frequency with which patients were discharged conscious (command-following).

Among 547 cardiac arrest patients admitted unconscious, characteristics were similar across hospitals and time (age, sex, race/ethnicity, arrest rhythm, comorbidities). Program-exposed patients underwent all guideline-compliant tests more frequently than contemporary patients at non-intervention hospitals or historical patients at the intervention hospital (23% vs 7% and 1%, respectively). The frequency of patients discharged conscious increased from 13% pre to 21% post at the intervention hospital, but not at non-intervention hospitals (15% pre to 12% post). LOS among surviving patients did not significantly change over this time at the intervention hospital (median 21.5 days [IQR 13.3-34.5] pre, 25 [17.5,35] post, p=0.75) or non-intervention hospitals (20.0 [9.8-33.1] pre, 20.5 [14.0,39.0], p=0.46).

A specialized neuroprognostication program is associated with an increase in the frequency of guideline-compliant testing, and the frequency of patients discharged conscious. Improvement in consciousness recovery does not reflect a general effect of time (as evidenced by non-intervention hospitals), nor a significant increase in program-associated LOS.