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Reader response: Clinical Reasoning: Prognostication after cardiac arrest: What do we really know?

The report by Beekman et al.1 highlighted the difficulties surrounding prognostication after cardiac arrest, particularly regarding posthypoxic myoclonus (PHM). We reviewed the literature on PHM and Lance-Adams syndrome (LAS) and their utility in prognostication after cardiac arrest.2–4 Despite the authors’ statement that LAS is distinguished by “the early onset of myoclonic status epilepticus (MSE),”1 historical definitions actually described LAS (“good” PHM) occurring after 24 hours postarrest, and MSE (“bad” PHM) more acutely. We found many cases of acute PHM associated with good outcomes, and that LAS may occur as early as 5 hours postarrest.4 This demonstrates the possible confusion defining PHM using time of onset.

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