Underutilization of a Post-Cardiac Arrest Consult Service for Standardization of a Guideline-Based Multimodal Neuroprognostication Algorithm in Comatose Cardiac Arrest Survivors (1658)

Objective: To estimate the utilization rates of a dedicated post-cardiac arrest consult service (PCACS) and individual components of a guideline-based neuroprognostication checklist in comatose survivors of cardiac arrest (CA). Background: Several CA survivors remain comatose after successful cardiopulmonary resuscitation. Recent guidelines recommend a standardized multimodal neuroprognostication scheme to prevent inappropriate withdrawal of life-sustaining treatment (WLST) and improve family satisfaction. Design/Methods: Consecutive patients admitted to intensive care units with a diagnosis of CA between July 2018 and June 2019 were included. Patients who died within 48 hours of CA, required Extracorporeal Membrane Oxygenation, or followed commands within 24 hours of CA were excluded. We calculated the total proportion of PCACS consults and compared utilization rates of individual elements of the prognostication checklist [i.e. pupillary exam off sedation, electroencephalography (EEG), computed tomography (CT) or magnetic resonance imaging (MRI), neuron-specific enolase (NSE), and somatosensory evoked potential (SSEP)] between patients who did and did not receive PCACS. Fisher9s exact tests were used for statistical comparisons. Results: Of the total 216 CA cases, 121 were eligible for the study (60% male; mean age 63±16.3). A PCACS was called for 66% (n = 80) of patients. Compared to patients who had a PCACS called, patients without PCACS demonstrated significantly lower utilization rates of the pupillary exam (94% vs 41%; p Conclusions: A substantial proportion of eligible comatose survivors of cardiac arrest did not receive PCACS or recommended neuroprognostication. Despite overall low uptake, a dedicated PCACS was associated with increased utilization of a multimodal prognostication algorithm in this patient population. Future studies utilizing mixed-methods should look into the effectiveness, barriers, and facilitators of implementing such a service. Disclosure: Wendy Tong has nothing to disclose. Dr. Waldrop has nothing to disclose. Dr. Thakur has nothing to disclose. Dr. Roh has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Portola Pharmaceuticals. Dr. Park has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Neurocritical Care. The institution of Dr. Park has received research support from National Institutes of Health. Dr. Claassen has received stock or an ownership interest from iCE Neurosystems. The institution of Dr. Claassen has received research support from NINDS. The institution of Dr. Claassen has received research support from McDonnel Foundation. Dr. Claassen has received publishing royalties from a publication relating to health care. Dr. Claassen has received publishing royalties from a publication relating to health care. Dr. Agarwal has nothing to disclose.