Abstract 47: Awakening After Cardiac Arrest and Post-Resuscitation Hypothermia: Are We Pulling the Plug too Early?
Introduction: Time to awakening after out-of-hospital cardiac arrest (OHCA) and post-resuscitation therapeutic hypothermia (TH) varies widely. The amount of time clinicians should wait before withdrawing supportive care for comatose patients after TH is unknown. We examined the time interval from when such patients had been fully re-warmed to 37oC to when they showed definitive signs of awakening.
Methods: With IRB approval, a retrospective study was performed in patients who presented to our center during 2007–2009 who were comatose on hospital admission after OHCA, treated with TH (target 33 oC) for 24 hours, re-warmed, and discharged alive. Our community hospital (St. Cloud Hospital, St. Cloud, MN) serves a population of ∼500K in central Minnesota. Comatose patients were generally treated after TH for at least 48 hours before any decision to withdraw supportive care was made. Pre-hospital TH was not used. Medical records were reviewed to find the time at which there were definitive signs of return of neurological function, including being alert and oriented to person, place, or time.
Results: A total of 66 patients (mean age 59.5 ± 5.6 years, 62% male) were included. The time from 911 to start of advanced life support care was 9.1 ± 8.0 minutes. Time to awakening is shown in the figure. All six patients with delayed awakening (> 72 hours) had good neurological function based upon a Cerebral Performance Category score of ≤ 2 within 30 days of OHCA. Five of 6 of these patients were intubated, comatose, and apneic 72 hours after re-warming.
Conclusion: Arbitrary withdrawal of life support 72 hours after re-warming may prematurely terminate life in at least 10% of all potentially neurologically intact survivors.
- © 2010 by American Heart Association, Inc.