Abstract 50: Interval Between Collapse and Restoration of Spontaneous Circulation Has Modest Association With Bad Neurological Outcomes in Patients Treated With Therapeutic Hypothermia
Background: Treatment with therapeutic hypothermia (TH) in patients following a cardiac arrest (CA) has been proven to lead to better neurological outcomes than those not treated with TH. However, a prolonged interval from collapse to restoration of spontaneous circulation (ROSC) in CA patients increases the chance of brain injury. We hypothesize that the time from collapse to ROSC will independently predict neurological outcomes in CA patients, but only modestly because of treatment with TH.
Methods: This is a prospectively collected data base analysis of 77 patients from 2007–2010 who were treated with TH following a successful resuscitation after CA. Neurological outcomes were assessed using the Pittsburgh Cerebral Performance Categories Scale (CPC) and were grouped into good (CPC: 1–2) and poor (CPC: 3–5) outcomes. Univariate and multivariate analyses were used to determine the effect the interval between collapse and ROSC had on neurological prognosis.
Results: Of 77 patients that underwent therapeutic hypothermia 55.8% (N=43) had poor outcomes and 44.2% (N=34) had good outcomes. Intervals to ROSC were significantly different (p= 0.001) between poor (27.79±18.06 minutes) and good (16.74 ± 9.23 minutes) outcome patients. With adjustment of variables including type of arrhythmia, STEMIs on admission, use of vasopressors, and surgical intervention, logistic regression revealed that length from collapse to ROSC is an independent predictor of neurological outcomes for CA patients treated with therapeutic hypothermia (odds ratio, 1.08; 95% CI, 1.02–1.14; p=0.005). C-index was 0.794 indicating good discrimination power of our model.
Conclusions: The interval between collapse and ROSC has modest association with bad neurological outcomes in CA survivors treated with therapeutic hypothermia.
- © 2010 by American Heart Association, Inc.