Neurological outcome and time to target temperature during therapeutic hypothermia in post-cardiac arrest patients

Abstract

Method: We conducted a database study at Cochin hospital in Paris, France. Between December 2006 and January 2010, we included 381 patients who were all resuscitated from an OHCA (excepted those with a primary neurological cause or moribunds). A moderate glycemic control was applied in all patients (aiming to maintain glycemia between 5.1 and 7.7mmol/l). BG was measured every 3h during the first 48h. The median glycemia and the largest delta were assessed. Amultivariate analysis was performed to determine parameters that independently influenced the main outcome (CPC level at ICU discharge). Results: 136/381 patients (36%) had a favorable outcome (CPC 1–2). Median BG level was 7.6mmol/l [6.3–9.8] in patients with a favorable outcome compared to 9.0mmol/l (IQR: 7.1–10.6) for patientswithanunfavorableneurologic outcome (p 8.4mmol/l) was found to be an independent predictor of poor neurological issue (OR=0.43; 95% CI [0.24–0.78], p=0.006). Other predictive factors of poor outcome were an unshockable rhythm, cardiac arrest location, a no flow >4min and a low flow >15min. Finally an increase in median BG was associated with an increase in the proportion of patients with a poor neurological outcome (Fig. 1). Conclusion: Even after adjustment with usual prognostic factors, an increase in glycemia during the first 48h is associated with an unfavorable neurological outcome.