Improvement of consciousness before initiating targeted temperature management

Abstract

IntroductionFollowing cardiac arrest, return of spontaneous circulation (ROSC) in patients may be followed by spontaneous neurological recovery, which may decrease the potential adverse effects of treatments in post-cardiac arrest care, including those of Targeted Temperature Management (TTM). We investigated the percentage of post-arrest patients who experienced spontaneous neurological recovery, and the characteristics and neurological outcomes of these patients. MethodsA total of 540 patients with ROSC were retrospectively enrolled in this single-center observational study. The patients’ motor responses were documented immediately and at 3 h following ROSC. Predictors of spontaneous neurological recovery were assessed by multiple logistic regression analysis. ResultsA total of 221 patients (41%) showed a change in their GCS (Glasgow Coma Score) M score (motor score) during the 3-h interval following ROSC, with improvement evident in 215 patients. Among 96 patients with GCS M6 at 3 h, 83 (86%) were discharged with a favorable neurological outcome. GCS M6 at 3 h post ROSC, was an independent predictor for a favorable neurological outcome, but GCS M6 at ROSC was not. There were four factors predicting the GCS M6 at 3 h; including in-hospital cardiac arrest (OR 3.057; 95% CI: 1.370–6.824, P = 0.006); bystander CPR (OR 13.311; 95% CI: 6.455–27.447, P < 0.0001); the CPR duration (OR, 0.941; 95% CI: 0.91–0.974; P < 0.0001), and the initial shockable rhythm (OR, 4.41; 95% CI: 2.44–7.95; P < 0.0001). ConclusionsA significant portion of patients had spontaneous neurological recovery to GCS M6 within 3 h post ROSC, and had a favorable neurological outcome. Close monitoring of GCS and later initiation of TTM should be considered in those patients with a substantial likelihood of neurological recovery.