Abstract 4038: Prediction of Outcome After Cardiac Arrest and Induced Hypothermia
Prediction of outcome in comatose survivors after cardiac arrest is difficult and is further complicated with the introduction of hypothermia as a treatment option, since sedation and intermittent use of paralyzers are mandated. Other means of prognostication, unaffected by pharmaceuticals, are warranted. We present data from a coma project, where the aim was to evaluate prognostic means by themselves or in combination. All patients included to hypothermia treatment after cardiac arrest, independent of the initial rhythm or the location of arrest, were included. A standardised protocol for monitoring and evaluation of neurological function and outcome was used (Fig 1⇓). Patients were assessed at 72 h after normothermia, at which time a decision on level of care was taken. During a four-year period, 106 consecutive patients were included; 19 were excluded because of death prior to evaluation (15), protocol violation (3) and intracerebral bleeding (1). Of the remaining 87 patients, 50 patients regained consciousness within 72 h after normothermia and 37 patients were still in coma (GCS≤7). Among these 37 patients, 8 patients eventually regained consciousness, whereas 29 did not. Our 8 patients with a late recovery had a positive profile regarding aEEG (continuous pattern), NSE (<27 ug/L at 48 h) and SSEP (cortical response), whereas 27 of 29 patients with persisting coma had at least one other strong marker for a bad outcome. A decision on level of care after cardiac arrest should be based on a neurological examination (GCS≤7) and at least one other prognostic tool. This should be performed no earlier than 72 h after normothermia.