Cognitive outcomes of patients undergoing therapeutic hypothermia after cardiac arrest (original) (raw)
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BMC Cardiovascular Disorders
Background This study is designed to provide detailed knowledge on cognitive impairment after out-of-hospital cardiac arrest (OHCA) and its relation to associated factors, and to validate the neurocognitive screening of the Targeted Hypothermia versus Targeted Normothermia after Out-of-Hospital Cardiac Arrest trial (TTM2-trial), assessing effectiveness of targeted temperature management after OHCA. Methods This longitudinal multi-center clinical study is a sub-study of the TTM2-trial, in which a comprehensive neuropsychological examination is performed in addition to the main TTM2-trial neurocognitive screening. Approximately 7 and 24 months after OHCA, survivors at selected study sites are invited to a standardized assessment, including performance-based tests of cognition and questionnaires of emotional problems, fatigue, executive function and insomnia. At 1:1 ratio, a matched control group from a cohort of acute myocardial infarction (MI) patients is recruited to perform the sam...
Resuscitation, 2014
Background: Previous reports have shown that prolonged duration of resuscitation efforts in out-ofhospital cardiac arrest (OHCA) is associated with poor neurologic outcome. This concept has recently been questioned with advancements in post-cardiac arrest care including the use of therapeutic hypothermia (TH). The aim of this study was to determine the rate of good neurologic outcome based on the duration of resuscitation efforts in OHCA patients treated with TH. Methods: This prospective, observational, study was conducted between January 2008 and September 2012. Inclusion criteria consisted of adult non-traumatic OHCA patients who were comatose after return of spontaneous circulation (ROSC) and received TH. The primary endpoint was good neurologic outcome defined as a cerebral performance category score of 1 or 2. Downtime was calculated as the length of time between the patient being recognized as pulseless and ROSC. Results: 105 patients were treated with TH and 19 were excluded due to unknown downtime, leaving 86 patients for analysis. The median downtime was 18.5 (10.0-32.3) min and 33 patients (38.0%) had a good neurologic outcome. When downtime was divided into four groups (≤10 min, 11-20 min, 21-30 min, >30 min), good neurologic outcomes were 62.5%, 37%, 25%, and 21.7%, respectively (p = 0.02). However, even with downtime >20 min, 22.9% had a good neurologic outcome, and this percentage increased to 37.5% in patients with an initial shockable rhythm. Conclusions: Although longer downtime is associated with worse outcome in OHCA patients, we found that comatose patients who have been successfully resuscitated and treated with TH have neurologically intact survival rates of 23% even with downtime >20 min.
Survival and neurologic recovery after out-of-hospital cardiac arrest
Halo 194, 2022
Introduction/Objective: Survival and neurologic recovery after out-of-hospital cardiac arrest remain poor despite significant advances in the therapeutic approach. The study aimed to evaluate predictors of intrahospital survival and neurologic outcome among patients after outof-hospital cardiac arrest as well as to evaluate the influence of mild therapeutic hypothermia introduction on intrahospital survival and neurologic outcome among comatose patients after out-of-hospital cardiac arrest. Methods The research was conducted as a retrospective observational study among patients hospitalized at the Cardiac Intensive Care Unit of the Institute for Cardiovascular Diseases of Vojvodina from January 2007 until November 2019 as a result of an out-of-hospital cardiac arrest. Results. The research included 506 survivors of OHCA. Multivariate regression analysis showed that initial shockable rhythm, cardiopulmonary resuscitation efforts lasting no longer than 20 minutes and a Glasgow Coma Score above 8 at admission, were predictors of intrahospital survival and good neurological outcome. Introduction of mild therapeutic hypothermia improved intrahospital survival (54.1% vs. 24.4%; p < 0.0005) and neurological outcome (42.9% vs. 18.3%; p < 0.0005) in comatose patients with initial shockable rhythm. Conclusion. In our study group of out-of-hospital cardiac arrest patients, initial shockable rhythm, cardiopulmonary resuscitation efforts lasting no longer than 20min and a Glasgow Coma Score above 8 at admission were predictors of intrahospital survival and favourable neurological outcome. The introduction of mild therapeutic hypothermia significantly improved survival and neurological outcomes in comatose patients with initial shockable rhythms.
Cor et Vasa, 2012
Background: Out-of-hospital cardiac arrest (OHCA) is a leading cause of death and severe neurological disability. The objective of this study was to identify clinical predictors of early neurological outcome in survivors of OHCA managed according to recent recommendations for OHCA care. Methods: Data from survivors of OHCA, admitted to a tertiary cardiac intensive care unit and treated with hypothermia in a 22 month period (n = 46, age 60 ± 13 y, 74% males) were retrospectively evaluated. At 1-month follow-up, patients were classified according to the best achieved Glasgow-Pittsburgh cerebral performance categories (CPC 1-5) and factors affecting the outcome were analyzed. Results: At 1-month follow-up, 23 patients (50%) had favourable outcome (CPC 1-2), while 23 patients (50%) had poor outcome (CPC 3-5), including 19 with in-hospital death (41% of total). Patients with good outcome were younger (55 ± 13 y vs. 66 ± 10 y; p = 0.003), had more often myocardial infarction as the cause of arrest (63% vs. 30%; p = 0.018) and ventricular fibrillation/tachycardia as an initial rhythm (78% vs. 39%; p = 0.007). Both groups differed by lactate level on admission (4.0 ± 4.6 vs. 7.3 ± 4.1 mmol/l, p = 0.02), after 12 hours (2.5 ± 1.1 vs. 4.3 ± 3.2 mmol/l, p = 0.04) and after 24 hours (1.9 ± 1.2 vs. 3.2 ± 1.9 mmol/l, p = 0.04). Logistic regression revealed the following independent outcome predictors: age, acute myocardial infarction and admission lactate level. Conclusion: Favourable outcome was observed in a half of OHCA survivors. Young age, acute myocardial infarction as underlying aetiology of cardiac arrest, and low lactate level on admission were the best predictors of favourable outcome. SOUHRN Kontext: Mimonemocniční srdeční zástava (out-of-hospital cardiac arrest-OHCA) je jedna z hlavních příčin úmrtí a závažného neurologického postižení. Cílem této studie bylo identifikovat klinické prediktory časného neurologického stavu u přeživších po OHCA, kteří byli léčeni podle posledních doporučení péče o pacienty po OHCA. Metodika: Retrospektivně byly analyzovány údaje o přeživších po OHCA, kteří byli přijati na oddělení intenzivní péče terciární úrovně a léčeni hypotermií v průběhu 22 měsíců (n = 46, věk 60 ± 13 r., 74 % mužů). Po jednom měsíci sledování byli pacienti rozděleni na základě nejlépe dosaženého neurologického stavu klasifikovaného dle Glasgow-Pittsburgh mozkových výkonnostních kategorií (cerebral performance categories-CPC 1-5). Další faktory ovlivňující neurologický nález byly též analyzovány. Výsledky: Po jednom měsíci sledování 23 pacientů (50 %) mělo příznivý neurologický nález (CPC 1-2), zatímco 23 pacientů (50 %) mělo nepříznivý nález (CPC 3-5) včetně 19 úmrtí v nemocnici (41 % z celkového počtu). Pacienti s příznivým neurologickým nálezem byli mladší (55 ± 13 r. vs. 66 ± 10 r., p = 0,003), měli častěji infarkt myokardu jako příčinu oběhové zástavy (63 % vs. 30 %, p = 0,018) a častější komorové
Indian Journal of Critical Care Medicine
IntRoductIon It is difficult to manage postcardiac arrest survivors because when treated with therapeutic hypothermia (TH), they commonly remain comatose after rewarming. In addition, previous studies conducted in patients who have undergone TH showed an increase in false-positive prediction for poor neurological outcome. [1] On the other hand, survivors without hypothermia have to be continuously sedated so the neurological prognostications for these survivors cannot be made accurately. [2] As a result of this, it is difficult to make a decision whether to withhold or withdraw life-sustaining treatment to unawake patients which the former choice can incur costly investigations and result in futile treatment, especially for those patients with irreversible conditions. In addition, there are limited data on the optimal time for neurological prognostication. Some recommendations, including those from the American Heart Association, suggest that physicians should delay the assessment beyond 72 h after the return of spontaneous circulation (ROSC). [3,4] Other guidelines recommend the prognostic assessment at 72 h after completing rewarming. [5] Thus, this study was conducted to evaluate the neurological predictive factors and the appropriate time for prognostication. The hypothesis was that the neurological symptoms, (viz., myoclonus and seizure), simple neurological signs at two different time points, and neurological investigations including electroencephalography (EEG), computed tomography of the brain (brain CT), may be able to predict the neurological outcomes in the survivors treated with hypothermia. Background: Currently, there are limited data of prognostic clues for neurological recovery in comatose survivors undergoing therapeutic hypothermia (TH). We aimed to evaluate clinical signs and findings that could predict neurological outcomes, and determine the optimal time for the prognostication. Materials and Methods: We retrospectively reviewed database of postarrest survivors treated with TH in our hospital from 2006 to 2014. Cerebral performance category (CPC), neurological signs and findings in electroencephalography (EEG) and brain computed tomography (CT) were evaluated. In addition, the optimal time to evaluate neurological status was analyzed. Results: TH was performed in 51 postarrest patients. Approximately 53% of TH patients survived at discharge and 33% of the hospital survivors had favorable outcome (CPC1-2). The prognostic clues for unfavorable outcome (CPC3-5) at discharge were lack of pupillary light response (PLR) and/or gag reflex after rewarming, and the absence of at least one of the brainstem reflexes, no eye-opening, or abnormal motor response on the 7 th day. Myoclonus and seizure could not be used to indicate poor prognosis. In addition, prognostic values of EEG and CT findings were inconclusive. Conclusions: Our study showed the simple neurological signs helped predict short-term neurological prognosis. The most reliable sign determining unfavorable outcome was the lack of PLR. The optimal time to assess prognosis was either at 48-72 h or 7 days after return of spontaneous circulation.
Intact neurological status after induced therapeutic hypothermia in cardiac arrest
Case Reports International, 2014
Introduction: cardiac arrest patients in whom return of spontaneous circulation (rOsc) is achieved after resuscitation frequently develop irreversible neurological impairments owing to hypoxic injury and reperfusion induced cell death. therapeutic hypothermia has become a standard strategy in specific unconscious adult patients with rOsc after out-of-hospital cardiac arrest (OHcA) as per American Heart Association (AHA) guidelines. case report: A 48-year-old south Asian male arrived to our emergency department with 20 minutes duration of OHcA with no basic life support (bLs) measures en route to hospital. His initial rhythm was ventricular fibrillation and he had rOsc after 13 minutes of cardiopulmonary resuscitation (cPr) and subsequently underwent therapeutic hypothermia for 24 hours and recovered completely without neurological impairment after eight days of incident. conclusion: therapeutic hypothermia in eligible cardiac arrest patients is an important component of the post-cardiac arrest care in the AHA chain of survival. the AHA chain of survival is a chain of five interdependent links for cardiac arrest and comprises early recognition, early cPr,