Response to De Jonghe et al. Prognostication of neurological e after cardiac arrest standardization of neurological examination conditions is needed.pdf

M. J. A. KampsJ. HornM. OddoJ. E. FugateC. StormT. CronbergO. WuJ. M. BinnekadeC. W. E. Hoedemaekers Response to De Jonghe et al.: Prognostication of neurological e after cardiac arrest: standardization of neurological examination conditions is needed Accepted: 22 November 2013 Published online: 5 December 2013 ? Springer-Verlag Berlin Heidelberg and ESICM 2013 Dear Editor,We thank Dr. De Jonghe for his interest in our meta-analysis on prognostication after cardiac arrest [ 1]. We agree with De Jonghe et al. that, in general, standardization of prognostic tests will improve the sensitivity and speci?city of the test [ 2]. Speci?cally in patients after car- diac arrest treated with hypothermia, timing of the prognostic tests, dosage of the sedatives, timing and decision to withdraw active treatment, and a large number of other known and unknown confounders will in?uence the e. As this was a meta- analysis, we could not control the timing or technical performance of the diagnostic tests in the original observational studies. We believe that the post cardiac arrest treatment and prognostication protocols described in the original studies re?ect current practice in a large number of hospi- tals worldwide. As such, the main conclusion of our analysis that absence of motor response and cor- neal re?exes at least 72 h after CPR are not reliable to predict poor out- come is robust and