Outcome In Cardiac Arrest Patients Research Articles

Renal Insufficiency and Early Bystander CPR Predict In-Hospital Outcomes in Cardiac Arrest Patients Undergoing Mild Therapeutic Hypothermia and Cardiac Catheterization: Return of Spontaneous Circulation, Cooling, and Catheterization Registry (ROSCCC Registry).

Objective. Out of hospital cardiac arrest (OHCA) patients are a critically ill patient population with high mortality. Combining mild therapeutic hypothermia (MTH) with early coronary intervention may improve outcomes in this population. The aim of this study was to evaluate predictors of mortality in OHCA patients undergoing MTH with and without cardiac catheterization. Design. A retrospective cohort of OHCA patients who underwent MTH with catheterization (MTH + C) and without catheterization (MTH + NC) between 2006 and 2011 was analyzed at a single tertiary care centre. Predictors of in-hospital mortality and neurologic outcome were determined. Results. The study population included 176 patients who underwent MTH for OHCA. A total of 66 patients underwent cardiac catheterization (MTH + C) and 110 patients did not undergo cardiac catheterization (MTH + NC). Immediate bystander CPR occurred in approximately half of the total population. In the MTH + C and MTH + NC groups, the in-hospital mortality was 48% and 78%, respectively. The only independent predictor of in-hospital mortality for patients with MTH + C, after multivariate analysis, was baseline renal insufficiency (OR = 8.2, 95% CI 1.8–47.1, and p = 0.009). Conclusion. Despite early cardiac catheterization, renal insufficiency and the absence of immediate CPR are potent predictors of death and poor neurologic outcome in patients with OHCA.

Subsequent shock deliveries are associated with increased favorable neurological outcomes in cardiac arrest patients who had initially non-shockable rhythms

IntroductionPrevious studies evaluating whether subsequent conversion to shockable rhythms in patients who had initially non-shockable rhythms was associated with altered clinical outcome reported inconsistent results. Therefore, we hypothesized that subsequent shock delivery by emergency medical service (EMS) providers altered clinical outcomes in patients with initially non-shockable rhythms.MethodsWe tested for an association between subsequent shock delivery in EMS resuscitation and clinical outcomes in patients with initially non-shockable rhythms (n = 11,481) through a survey of patients after out-of-hospital cardiac arrest in the Kanto region (SOS-KANTO) 2012 study cohort, Japan. The primary investigated outcome was 1-month survival with favorable neurological functions. The secondary outcome variable was the presence of subsequent shock delivery. We further evaluated the association of interval from initiation of cardiopulmonary resuscitation to shock with clinical outcomes.ResultsIn the univariate analysis of initially non-shockable rhythms, patients who received subsequent shock delivery had significantly increased frequency of return of spontaneous circulation, 24-hour survival, 1-month survival, and favorable neurological outcomes compared to the subsequent not shocked group (P <0.0001). In the multivariate logistic regression analysis, subsequent shock was significantly associated with favorable neurological outcomes (vs. not shocked; adjusted P = 0.0020, odds ratio, 2.78; 95 % confidence interval, 1.45–5.30). Younger age, witnessed arrest, initial pulseless electrical activity rhythms, and cardiac etiology were significantly associated with the presence of subsequent shock in patients with initially non-shockable rhythms.ConclusionsIn this study of cardiac arrest patients with initially non-shockable rhythms, patients who received early defibrillation by EMS providers had increased 1-month favorable neurological outcomes.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-015-1028-0) contains supplementary material, which is available to authorized users.

Abstract 18794: Systemic Heparin Use and Outcomes in Cardiac Arrest Patients Treated With Therapeutic Hypothermia Without Coronary Intervention

Introduction: The effects of hypothermia on hemostatic function are complex and poorly understood. While cardiac arrest and CPR can elicit a pro-inflammatory, pro-coagulant state, hypothermia may alter platelet count, activation and aggregation. Hypothesis: We hypothesized that treatment with systemic heparin during therapeutic hypothermia (TH) is associated with improved neurologic outcomes. Methods: We conducted a retrospective study of 157 cardiac arrest survivors treated with TH at our institution from 2007-2014. A priori, we excluded TH patients (pts) presenting with an acute coronary syndrome requiring percutaneous coronary intervention, pulmonary embolus, venous thrombosis or need for mechanical circulatory support. We used a multivariable logistic regression model to examine the relationship between systemic heparin and neurologic outcome (Cerebral Performance Category score 1-2=good; 3-5=poor) as well as inpatient survival. We also performed a chi-square analysis for the secondary endpoint of major bleeding. Results: Mean age was 57.0 (+/- 16.2) years; 86 (54%) pts were male; and 75 (47.8%) pts had an initial rhythm of ventricular tachycardia or ventricular fibrillation. At discharge, 48 (30.6%) pts had a good neurologic outcome and 23 (14.7%) pts suffered from a major bleed. Systemic heparin was administered to 48 (30.6%) pts, and was neither associated with favorable neurologic outcome (OR 0.99, CI 0.39-2.56, p=0.991) nor inpatient survival (OR 1.28, CI 0.54-3.05, p=0.574). The risk of bleeding with heparin was 2.08 (CI 0.99-4.38, p=0.052). Conclusions: In our cohort, indiscriminate use of systemic heparin during TH post-cardiac arrest was not associated with improved neurologic outcomes. Conversely, a trend towards increased risk of major bleeding was noted.

Abstract 10888: Impact of Sodium Bicarbonate on Survival in Patients With Prolonged Out-of-Hospital Cardiac Arrest; SOS-KANTO study 2002 &amp; 2012

Introduction: The impact of sodium bicarbonate (SB) usage on survival outcomes in patients who have prolonged cardiac arrest (CA) remains unclear. A change in the overall use of SB has occurred over the last decade due to changes in ILCOR recommendations. This natural experiment in the SB use provides an opportunity to explore the association of SB and possible benefits in survival from CA. Objective: To evaluate the association between SB use and outcomes of CA patients; and to describe temporal patterns of SB use and factors related to SB usage Methods: In 2002-03 and 2012-13, we identified 9,592 and 16,452 patients, respectively, from two cohorts in Japan. All adult OHCA patients were included. Patients who gained return of spontaneous circulation in pre-hospital settings were excluded as prolonged CA was selected. The primary and secondary outcomes were successful hospital admission and 1 month survival. Factors associated with SB usage were assessed by multivariable logistic regression analysis. Results: Overall SB usage decreased from 17.3% (n=6,652) in 2002, to 9.7% (n=10,970) in 2012. Patients who received SB had significantly higher rates of admission compared with non-SB patients during both time periods (33.8% vs. 15.4% in 2002, and 39.3% vs. 17.2% in 2012, respectively, p&lt;.001) and significantly higher 1m-survival (4.8% vs. 2.1%, and 4.1% vs. 1.9%, p&lt;.001). Logistic regression demonstrated that SB use was significantly associated with admission (adjusted odds ratio, 2.74 [95%CI 2.29-3.27], p&lt;0.001 in 2002, and 2.68 [2.27-3.18], p&lt;0.001 in 2012) and 1m-survival (2.07 [1.42-3.01], p&lt;0.001, and 1.55 [1.05-2.29], p=0.03) adjusting for possible confounders. Intubation and defibrillation within the ER were most associated with SB usage in both cohorts, while blood pH, potassium levels, and cause of poisoning were not associated with SB use in either cohort. Conclusions: SB usage was associated with increased survival rates in patients with OHCA transported to the ED in CA. Factors related to current CPR guidelines, that suggest more prolonged ED efforts such as intubation and defibrillation are associated with SB use. Surprisingly blood pH showed no association with SB use. Additional studies on the optimal role for SB during CA seem warranted.

103 Does Video-Assisted Laryngoscopy Improve Outcomes in Cardiac Arrest Patients Who Are Intubated Out-of-Hospital?

Out-of-hospital intubation of cardiac arrest patients is controversial with some studies suggesting that the intubation process limits effective compressions. However, advances in video-assisted laryngoscopy (VAL) have improved the efficiency of intubation. It is unclear if the use of VAL improves outcomes in cardiac arrest patients who are intubated out-of-hospital. We sought to determine if there is improved survival to hospital admission in cardiac arrest patients who are intubated out-of-hospital using VAL versus those in whom traditional direct laryngoscopy (DL) is used. Design: Retrospective Cohort. Setting: A large suburban, two-tiered advanced life support (ALS) system that evaluates approximately 27,000 patients per year. Subjects: Consecutive patients in cardiac arrest who were intubated out-of-hospital by ALS providers over an 18-month period. Patients were divided into groups based on whether VAL or direct laryngoscopy was used as the method for intubation. ALS providers are encouraged to use VAL as the primary method of intubation, but can use DL at their discretion. We reviewed patient records to determine the intubation method used, whether the intubation was successful on the first attempt, and whether the patient survived to hospital admission. We compared the differences between the rates of survival to admission between the two groups and calculated 95% confidence intervals (CI). Out of 480 total intubations, there were 354 in the VAL group and 126 in the DL group. 64% of the VAL group and 73% of the DL group were in cardiac arrest. There were no differences in age or sex between the two groups. First attempt success rate was 76% (72, 80) in the VAL group and 84% (76, 91) in the DL group (difference 8%, CI -3, 16). Survival to hospital admission was 33% (CI: 27, 39) in the VAL group and 15% (CI: 8, 23) in the DL group. The difference in survival to hospital admission was 17% (CI: 7, 26; P < .05). Compared to DL, VAL appears to improve survival to hospital admission in cardiac arrest patients who are intubated out-of-hospital.

Right ventricular dysfunction after resuscitation predicts poor outcomes in cardiac arrest patients independent of left ventricular function

ObjectiveDetermination of clinical outcomes following resuscitation from cardiac arrest remains elusive in the immediate post-arrest period. Echocardiographic assessment shortly after resuscitation has largely focused on left ventricular (LV) function. We aimed to determine whether post-arrest right ventricular (RV) dysfunction predicts worse survival and poor neurologic outcome in cardiac arrest patients, independent of LV dysfunction. MethodsA single-center, retrospective cohort study at a tertiary care university hospital participating in the Penn Alliance for Therapeutic Hypothermia (PATH) Registry between 2000 and 2012. Patients291 in- and out-of-hospital adult cardiac arrest patients at the University of Pennsylvania who had return of spontaneous circulation (ROSC) and post-arrest echocardiograms. Measurements and main resultsOf the 291 patients, 57% were male, with a mean age of 59±16 years. 179 (63%) patients had LV dysfunction, 173 (59%) had RV dysfunction, and 124 (44%) had biventricular dysfunction on the initial post-arrest echocardiogram. Independent of LV function, RV dysfunction was predictive of worse survival (mild or moderate: OR 0.51, CI 0.26–0.99, p<0.05; severe: OR 0.19, CI 0.06–0.65, p=0.008) and neurologic outcome (mild or moderate: OR 0.33, CI 0.17–0.65, p=0.001; severe: OR 0.11, CI 0.02–0.50, p=0.005) compared to patients with normal RV function after cardiac arrest. ConclusionsEchocardiographic findings of post-arrest RV dysfunction were equally prevalent as LV dysfunction. RV dysfunction was significantly predictive of worse outcomes in post-arrest patients after accounting for LV dysfunction. Post-arrest RV dysfunction may be useful for risk stratification and management in this high-mortality population.

Clinical Outcomes in Cardiac Arrest Patients Following Prehospital Treatment with Therapeutic Hypothermia.

Recent studies have brought to question the efficacy of the use of prehospital therapeutic hypothermia for victims of out-of-hospital cardiac arrest (OHCA). Though guidelines recommend therapeutic hypothermia as a critical link in the chain of survival, the safety of this intervention, with the possibility of minimal treatment benefit, becomes important. Hypothesis/Problem This study examined prehospital therapeutic hypothermia for OHCA, its association with survival, and its complication profile in a large, metropolitan, fire-based Emergency Medical Services (EMS) system, where bystander cardiopulmonary resuscitation (CPR) and post-arrest care are in the process of being optimized. This evaluation was a retrospective chart review of all OHCA patients with return of spontaneous circulation (ROSC) treated with therapeutic hypothermia, from January 1, 2013 through November 30, 2013. The primary outcomes were the proportion of patients with initiation of prehospital therapeutic hypothermia with survival to hospital admission, the proportion of patients with initiation of prehospital therapeutic hypothermia with survival to hospital discharge, and the complication profile of therapeutic hypothermia in this population. The complication profile included several clinical, radiographic, and laboratory parameters. Exclusion criteria included: no prehospital therapeutic hypothermia initiation; no ROSC; and age of 17 year old or younger. Fifty-one post-cardiac arrest patients were identified that met inclusion criteria. The mean age was 61 years (SD=14.7 years), and 33 (72%) were male. The initial rhythm was ventricular fibrillation or pulseless ventricular tachycardia in 17 (37%) patients, and bystander CPR was performed in 28 (61%) patients with ROSC. Thirty-nine (85%) patients survived to hospital admission. Twenty-one patients (48%; 95% CI, 33-64) were administered vasopressors, 10 patients (24%; 95% CI, 10-37) were administered diuretics, and 19 patients (44%; 95% CI, 29-60) were administered antibiotics. Initial chest radiograph (CXR) findings were normal in 12 (29%) patients. Overall, 13 (28%; 95% CI, 15-42) study patients survived to hospital discharge. Recent reports have questioned the efficacy and safety of prehospital therapeutic hypothermia. In this evaluation, in the setting of unstandardized post-arrest care, 85% of the patients survived to hospital admission and 28% survived to hospital discharge, with a complication profile which was similar to that noted in other studies. This suggests that further evidence may be needed before EMS systems stop administering therapeutic hypothermia to appropriately selected patients. In less-optimized systems, therapeutic hypothermia may still be an essential link in the chain of survival.

Repeated diffusion weighted imaging in comatose cardiac arrest patients with therapeutic hypothermia

BackgroundThe aim of this study was to evaluate the changing pattern and prognostic values of diffusion-weighted imaging (DWI) at two time points in cardiac arrest patients treated with therapeutic hypothermia. MethodsTwenty two patients with cardiac arrest who underwent two DWI studies were enrolled in the retrospective study. The first DWI was performed after the induction of therapeutic hypothermia (median 6.0h) and was repeated between 48h and 168h (second DWI, median 74h). Apparent diffusion coefficient (ADC) values were measured in the predefined brain regions, and qualitative analysis was also performed. Good neurologic outcomes were defined as Cerebral Performance Category (CPC) scores of 1 and 2. ResultsThe ADC value tended to increase over time except the cortical regions of the poor outcome group (N=10). In the comparisons of receiver operating characteristic (ROC) curve to predict poor outcome using ADC value, postcentral cortex in the second DWI has a better association with neurological outcome (p=0.001, area under the curve (AUC)=0.996 for second DWI, AUC=0.571 for first DWI). In the same analysis using qualitative score, precentral cortex, postcentral cortex, parietal lobe, occipital lobe, caudate and putamen in the second DWI have a better association with neurological outcome. ConclusionsThe changing pattern of ADC values after cardiac arrest is different according to anatomic region and neurologic status. The DWI after 48h has a better association with neurological outcome of cardiac arrest patients in both quantitative and qualitative analysis.

Effect of prehospital initiation of therapeutic hypothermia in adults with cardiac arrest on time-to-target temperature.

Despite growing adoption, the impact of prehospital initiation of therapeutic hypothermia on outcomes of cardiac arrest patients is unknown. The objective of this study was to determine if prehospital administration of cold intravenous fluids improved the time-to-target temperature. All patients enrolled in an institutional post- cardiac arrest treatment pathway were prospectively registered into a quality assurance database. Patients undergoing cooling induction on hospital arrival were compared to those receiving a new treatment protocol initiated during the study period involving prehospital cooling with 4°C (39.2°F) normal saline. The primary outcome was the time-to-target temperature. Secondary outcomes included emergency medicine system transport time metrics, mortality, and neurologic status at discharge and 1 year. One hundred thirty-two patients were enrolled during the study period. The initial rhythm was ventricular fibrillation/tachycardia in 63% and asystole/pulseless electrical activity in 36%. Eighty patients received prehospital cooling and 52 patients did not and comprised the historical control group. Time-to-target temperatures were not significantly different between prehospital and hospital cooled groups (256 v. 271 minutes, respectively, p=0.64), nor was there any improvement in hospital survival (54% v. 50%, p=0.67), good neurologic outcome (49% v. 44%, p=0.61), or 1- year survival (49% v. 42%, p=0.46) between the two groups. Transport times were longer in the prehospital cooled group. Out-of-hospital cardiac arrest patients treated with prehospital cooling before arrival at our urban hospital did not have faster time-to-target temperature or improvement in outcomes compared to patients cooled immediately on emergency department arrival. Further research is needed to determine if any benefits exist from prehospital cooling prior to its widespread adoption.

Abstract 105: Changes in NIRS-Measured Cerebral Tissue Oxygen Saturation During Hyperventilation: A Comparison Between NIRO™ and INVOS™

Introduction: Cerebral tissue oxygen saturation measured with transcranial near-infrared spectroscopy (NIRS) has been reported to predict neurological outcome of cardiac arrest patients. Because NIRS values are confounded by extracranial tissues, there can be considerable inter-device variation in the measured values. We compared hyperventilation-induced changes in NIRS values measured with 2 commercially available devices in healthy volunteers. Methods: After obtaining an approval from the ethics committee at Iseikai hospital and written informed consents, 29 healthy volunteers joined the study. Probes of NIRO™ 200NX (Hamamatsu Photonics, Japan) and INVOS™ 5100C (Covidien, USA) were applied respectively on the right and left side of the volunteers’ forehead. After obtaining the baseline values, the volunteers were asked to hyperventilate for 40 seconds attempting to reduce the end-tidal CO 2 by ~20 mmHg. Measurements were repeated, after 20 minutes of resting interval, with the probes applied on the contralateral sides. Hyperventilation-induced response of the NIRS value was categorized as “correct” when the average value over the 5 second period toward the end of the hyperventilation decreased by &gt;15% the baseline or “erroneous” otherwise. Results: The mean (± SD) end-tidal CO 2 decreased from the baseline value of 36 ± 5.1 mmHg to 15.2 ± 4.4 mmHg during hyperventilation. Out of 58 measurements with each of the devices, NIRO values were “correct” in 54 (93.1%) measurements, whereas INVOS values were “correct” in 32 (52.2%) measurements. NIRO presented “erroneous” values on both sides of the forehead in no volunteers whereas INVOS presented “erroneous” values in 7 (35%) of 29 volunteers. Discussion: Hyperventilation consistently decreases cerebral blood flow in healthy subjects. Thus, the results of the present study suggest that NIRS devices may fail to reflect correct changes in cerebral tissue oxygen saturation in ~7% of measurements with NIRO and in ~48% with INVOS. The bilateral “erroneous” measurements with INVOS in 7 (35%) volunteers may suggest that INVOS is subject to confounding by extracranial tissues. A potential source of confounding may include the scalp where blood flow increases during hyperventilation.

A pilot assessment of alpha-stat vs pH-stat arterial blood gas analysis after cardiac arrest

PurposeResuscitated cardiac arrest (CA) patients typically receive therapeutic hypothermia, but arterial blood gases (ABGs) are often assessed after adjustment to 37°C (alpha-stat) instead of actual body temperature (pH-stat). We sought to compare alpha-stat and pH-stat assessment of Pao2 and Paco2 in such patients. Materials and methodsUsing ABG data obtained during the first 24 hours of intensive care unit admission, we determined the impact of measured alpha vs calculated pH-stat on Pao2 and Paco2 on patient classification and outcomes for CA patients. ResultsWe assessed 1013 ABGs from 120 CA patients with a median age of patients 66 years (interquartile range, 50-76). Median alpha-stat Pao2 changed from 122 (95-156) to 107 (82-143) mm Hg with pH-stat and median Paco2 from 39 (34-46) to 35 (30-41) mm Hg (both P < .001). Using the categories of hyperoxemia, normoxemia, and hypoxemia, pH-stat estimation of Pao2 reclassified approximately 20% of patients. Using the categories of hypercapnia, normocapnia, and hypocapnia, pH stat estimation of Paco2 reclassified approximately 40% of patients. The mortality of patients in different Pao2 and Paco2 categories was similar for pH-stat and alpha-stat. ConclusionsUsing the pH-stat method, fewer resuscitated CA patients admitted to intensive care unit were classified as hyperoxemic or hypercapnic compared with alpha-stat. These findings suggest an impact of ABG assessment methodology on Pao2, Paco2, and patient classification but not on associated outcomes.

The impact of oxygen and carbon dioxide management on outcome after cardiac arrest

To describe the impact of oxygen and carbon dioxide management on patient outcomes following cardiac arrest. Although there are no data that suggest that supplemental oxygen administration during cardiopulmonary resuscitation is harmful, there is concern that 100% oxygen during the postresuscitation phase may be undesirable. The evidence to avoid hyperoxia is limited to animal studies and retrospective clinical studies that examine the association between exposure and outcome. There is a correlation between end-tidal carbon dioxide values during cardiopulmonary resuscitation and resuscitation outcome, yet this correlation is likely to reflect low or absent cardiac output and be a biomarker of illness severity rather than a mediator of injury. Additionally, very limited high-level human data exist on the relationship between arterial carbon dioxide tension and outcome following cardiac arrest. Retrospective studies have identified hypocapnia in the intensive care unit as being independently associated with worse neurological and mortality outcomes in cardiac arrest patients. Although there appears to be sufficient evidence to recommend avoiding hypocapnia after resuscitation, observational data suggest that hypercapnia may be independently associated with a greater likelihood of discharge home amongst cardiac arrest survivors. Current data for oxygen and carbon dioxide management following resuscitation suggest that hyperoxia and hypocapnia may be injurious and should be avoided, and that mild hypercapnia may increase the likelihood of discharge home amongst survivors. Such data should be viewed as hypothesis generating. Randomized controlled trials have commenced to clarify the safety, feasibility and efficacy of targeting different oxygen and carbon dioxide tensions following cardiac arrest.

Effect of intensive care after cardiac arrest on patient outcome: a database analysis

IntroductionThe study aimed to determine the impact of treatment frequency, hospital size, and capability on mortality of patients admitted after cardiac arrest for postresuscitation care to different intensive care units.MethodsProspectively recorded data from 242,588 adults consecutively admitted to 87 Austrian intensive care units over a period of 13 years (1998 to 2010) were analyzed retrospectively. Multivariate analysis was used to assess the effect of the frequency of postresuscitation care on mortality, correcting for baseline parameters, severity of illness, hospital size, and capability to perform coronary angiography and intervention.ResultsIn total, 5,857 patients had had cardiac arrest and were admitted to an intensive care unit. Observed hospital mortality was 56% in the cardiac-arrest cohort (3,302 nonsurvivors). Patients treated in intensive care units with a high frequency of postresuscitation care generally had high severity of illness (median Simplified Acute Physiology Score (SAPS II), 65). Intensive care units with a higher frequency of care showed improved risk-adjusted mortality. The SAPS II adjusted, observed-to-expected mortality ratios (O/E-Ratios) in the three strata (<18; 18 to 26; >26 resuscitations per ICU per year) were 0.869 (95% confidence interval, 0.844 to 894), 0.876 (0.850 to 0.902), and 0.808 (0.784 to 0.833).ConclusionsIn this database analysis, a high frequency of post-cardiac arrest care at an intensive care unit seemed to be associated with improved outcome of cardiac-arrest patients. We were able to identify patients who seemed to profit more from high frequency of care, namely, those with an intermediate severity of illness. Considering these findings, cardiac-arrest care centers might be a reasonable step to improve outcome in this specific population of cardiac-arrest patients.

Association between mean arterial blood gas tension and outcome in cardiac arrest patients treated with therapeutic hypothermia

BackgroundStudies investigating the relationship between blood gas tension and outcome in cardiac arrest survivors have reported conflicting results. This might have resulted from the use of a blood gas value at a single time point and the difference in the proportion of patients treated with therapeutic hypothermia (TH). We investigated the association of the mean blood gas tensions calculated from blood gas values obtained between restoration of spontaneous circulation and end of TH with the outcome in cardiac arrest patients treated with TH. MethodsThis was a retrospective observational study including 213 adult cardiac arrest patients. The cohort was divided into four categories based on the distribution of the mean Pao2 data using quartiles as cut-off values between categories. According to the mean Paco2, the cohort was divided into hypocarbia, normocarbia, and hypercarbia. The primary outcome was in-hospital mortality. ResultsIn multivariate analysis, the mean Pao2 quartile was not associated with in-hospital mortality, but hypocarbia was significantly associated with increased risk of in-hospital mortality (odds ratio 2.522; 95% confidence interval 1.184-5.372; P = .016). We found a V-shaped independent association between the mean Pao2 and poor neurologic outcome at hospital discharge, with the risk of poor neurologic outcome increasing with a descending and ascending Pao2 ranges. ConclusionMean Pao2 had no independent association with in-hospital mortality whereas hypocarbia was independently associated with in-hospital mortality. We also found a V-shaped independent association between the mean Pao2 and poor neurologic outcome at hospital discharge.

Clinical Predictors of Neurologic Outcome in Cardiac Arrest Patients Post Induced Hypothermia

Clinical Predictors of Neurologic Outcome in Cardiac Arrest Patients Post Induced Hypothermia

Neurological Outcomes in Cardiac Arrest Patients Who Underwent Therapeutic Hypothermia (Comparison With Control Group)

Neurological Outcomes in Cardiac Arrest Patients Who Underwent Therapeutic Hypothermia (Comparison With Control Group)

Comparisons of Outcomes in Cardiac Arrest Patients Undergoing Therapeutic Hypothermia With and Without Cardiac Catheterization: Return of Spontaneous Circulation, Cooling and Catheterization Registry (Rosccc Registry)

There is emerging evidence to support mild therapeutic hypothermia (MTH) and early revascularization post witnessed VT/VF arrest improve neurologic outcomes and mortality. However it is not clear which cohort of patients post cardiac arrest are or should be taken to cardiac catheterization. We report the first comparative Canadian outcome data for patients resuscitated from cardiac arrest who underwent MTH with and without cardiac catheterization.

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Prognostication of neurologic outcome in cardiac arrest patients after mild therapeutic hypothermia: a meta-analysis of the current literature

To assess the sensitivity and false positive rate (FPR) of neurological examination and somatosensory evoked potentials (SSEPs) to predict poor outcome in adult patients treated with therapeutic hypothermia after cardiopulmonary resuscitation (CPR). MEDLINE and EMBASE were searched for cohort studies describing the association of clinical neurological examination or SSEPs after return of spontaneous circulation with neurological outcome. Poor outcome was defined as severe disability, vegetative state and death. Sensitivity and FPR were determined. A total of 1,153 patients from ten studies were included. The FPR of a bilaterally absent cortical N20 response of the SSEP could be calculated from nine studies including 492 patients. The SSEP had an FPR of 0.007 (confidence interval, CI, 0.001-0.047) to predict poor outcome. The Glasgow coma score (GCS) motor response was assessed in 811 patients from nine studies. A GCS motor score of 1-2 at 72 h had a high FPR of 0.21 (CI 0.08-0.43). Corneal reflex and pupillary reactivity at 72 h after the arrest were available in 429 and 566 patients, respectively. Bilaterally absent corneal reflexes had an FPR of 0.02 (CI 0.002-0.13). Bilaterally absent pupillary reflexes had an FPR of 0.004 (CI 0.001-0.03). At 72 h after the arrest the motor response to painful stimuli and the corneal reflexes are not a reliable tool for the early prediction of poor outcome in patients treated with hypothermia. The reliability of the pupillary response to light and the SSEP is comparable to that in patients not treated with hypothermia.

Combining brain computed tomography and serum neuron specific enolase improves the prognostic performance compared to either alone in comatose cardiac arrest survivors treated with therapeutic hypothermia

Aim of the studyWe determined whether combining the grey-to-white matter ratio (GWR) on brain computed tomography (CT) and serum neuron specific enolase (NSE) improves the prognostic performance when compared to either alone in cardiac arrest patients treated with therapeutic hypothermia (TH). MethodsWe performed a retrospective study of a cohort of cardiac arrest patients treated with TH. The Hounsfield unit was measured in the caudate nucleus (CN), putamen (P), posterior limb of internal capsule (PIC) and corpus callosum (CC); GWR was calculated as CN/PIC and P/CC. The NSE value was obtained at 0, 24, and 48h after restoration of spontaneous circulation (ROSC). We analysed the prognostic performance of GWR and NSE, singly and in combination, in predicting poor neurologic outcome (cerebral performance category 3–5). ResultsOf the 224 included patients, 82 showed good neurologic outcome at hospital discharge, while 142 showed poor neurologic outcome. The P/CC (area under receiver operating characteristics (AUROC) 0.864, sensitivity/specificity 52.9%/100%) showed better prognostic performance than did the CN/PIC (AUROC 0.721, sensitivity/specificity 19.8%/100%). The NSE value at 48h after ROSC (AUROC 0.895, sensitivity/specificity 60.2%/100%) showed the highest prognostic value among the three NSE time points. Analysis of 119 patients undergoing both brain CT and NSE at 48h indicated that combining P/CC and NSE improved the sensitivity (78.6%) compared to either alone (48.6%, 62.9%). ConclusionCombining brain CT and serum NSE improves the prognostic performance when compared to either alone in predicting poor neurologic outcome in cardiac arrest patients treated with TH.