Abstract 226: Relation Between Glasgow Coma Scale Motor Score Immediately After ROSC and Neurologic Outcomes in Patients Treated With Hypothermia After Out-of-Hospital Cardiac Arrest: J-PULSE-Hypo Registry

Abstract

Background: The 2010 American Heart Association Guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC) recommend that comatose adult patients with return of spontaneous circulation (ROSC) after out-of-hospital ventricular fibrillation (VF) cardiac arrest should receive therapeutic hypothermia (Class I). However, it remains unclear whether Glasgow Coma Scale (GCS) immediately after ROSC predicts neurologic outcome in patients treated with hypothermia after out-of-hospital cardiac arrest. Methods: We conducted a multicenter retrospective study at 14 institutions to evaluate the effect of therapeutic hypothermia on out-of-hospital cardiac arrest between January 2005 and March 2011 (505 patients). The study committee entrusted each hospital with the timing of cooling, cooling methods, target temperature, duration, and rewarming rate. In the patients with ROSC at hospital arrivals, the relationship between GCS score at hospital arrivals and neurological outcomes were analyzed. Neurologic outcomes at 90 days after cardiac arrest were examined. A favorable outcome was defined as a Cerebral Performance Category (CPC) of 1-2. Results: A total of 100 patients were studied. GCS score at hospital arrivals was distributed from 3 to 10. GCS motor scale at hospital arrivals was distributed from M1 (n=64), M2 (n=9), M3 (n=10), M4 (n=15), to M5 (n=2). Time interval between ROSC and hospital arrivals was distributed from 0 to 51 min (median 10 min, IQR: 5 - 17). A favorable outcome at 90 days after cardiac arrest was observed in 89 patients (89 %). All patients with GCS M4 and M5 (n=17) in which examined within 22 min after ROSC predict favorable outcome. Among the patients with GCS M1-3 (n=83) in which examined within 51 min after ROSC, favorable outcome was observed in 87 % (n=72) patients. Conclusions: Our results suggest that GCS motor scale at hospital arrivals after ROSC before induction of therapeutic hypothermia predict favorable outcomes.