**12. Clinical examination**

Clinical examination can be prone to misinterpretation from interference from confounding factors such as sedatives, muscle relaxants, and opioids. The presence of any confounding factors should be excluded to achieve a reliable interpretation from clinical examination of the patient. A motor score of ≤3 in the Glasgow coma score (abnormal flexion or worse in response to pain) at 72 h or later after ROSC, may indicate poor neurological outcome and the need for neurological prognostication. The poor neurological outcome can be predicted by the following test results from clinical examination [3].

#### **13. Neurophysiology**

An EEG should be performed on all comatose patients following cardiac arrest. The presence of subclinical seizure activity on EEG in the first 72 h following ROSC is an indicator of poor prognosis. Highly malignant EEG patterns include suppressed background with or without periodic discharges and burst suppression. After cardiac arrest, the EEG is suppressed in many patients but returns to normal voltage activity within the first 24 h in patients who achieve a good outcome [13].

*The Initial Assessment and Management of the Post-Cardiac Arrest Patient DOI: http://dx.doi.org/10.5772/intechopen.100132*

Somatosensory evoked potentials can be performed by electrically stimulating a nerve e.g., the median nerve, and the ascending signals can be recorded from the peripheral plexus brachialis, cervical level, subcortical level, and the sensory cortex (N20-potential). A bilateral absence of the short-latency N20-potentials over the sensory cortex is a reliable sign of a poor prognosis after cardiac arrest with high specificity [3].

### **14. Biomarkers**

Neuron-specific enolase (NSE) is an acidic protease unique to neurons and is sensitive to damage to nerve cells. NSE decreases after 24 h in patients with good outcomes and typically increases in patients with a poor outcome to peak at 48–96 h [14].

### **15. Imaging**

The use of brain imaging studies can help predict patients with poor neurological outcomes. The presence of generalized brain edema, manifested by a marked reduction of the gray matter/white matter ratio on CT brain scan, or extensive diffusion restriction on brain MRI can predict poor neurological outcomes after cardiac arrest. Further signs of diffuse and extensive hypoxic-ischemic brain injury on brain CT include an effacement of cortical sulci and reduced ventricle size [3].

#### **16. Long term outcome in cardiac arrest survivors**

Cognitive impairments, emotional problems, and fatigue are common following cardiac arrest [15]. The morbidities can be missed by healthcare professionals. These can have a significant impact on the quality of life of patients and should be addressed for cardiac arrest survivors and monitored on follow-up to allow early detection and intervention with appropriate care [3].

Functional assessments of physical and emotional impairments should be performed before discharge from the hospital to help identify patients requiring early intervention and rehabilitation. Cardiac arrest survivors should be followed up within 3 months post-discharge and be screened for cognitive, emotional problems, and be provided information and support [3].

*Cardiac Arrhythmias - Translational Approach from Pathophysiology to Advanced Care*
