Abstract 10778: Relation Between Time to Arousal and Neurologic Outcomes in Cardiac Arrest Patients Treated with Therapeutic Hypothermia
Background: The use of therapeutic hypothermia (TH) improves outcomes after resuscitation from cardiac arrest. However, patients often remain comatose for days following resuscitation and therefore neuroprognostication remains a major challenge. Few data exist to describe the time course of arousal following resuscitation.
Objective: To determine factors that influence the time it takes patients to regain purposeful movement after resuscitation and subsequent TH.
Methods: We retrospectively studied post-arrest patients who were treated with TH between 5/2005 - 10/2010 in a 3 hospital cohort using the from a newly developed internet-based US registry of post-cardiac arrest TH patients. We measured the time from arrest until first documentation of Glasgow motor score of 6 or chart notation of following commands purposefully (“arousal”).
Results: We included 154 consecutive patients for analysis. Mean age was 57±16 years; 86/154 (56%) were male. Initial rhythm was VF/VT in 59/154 (38%); survival to hospital discharge was achieved in 66/154 (42%), and of these, 48/66 (73%) had a good neurological outcome. Of patients who regained arousal 67/154 (43%), the mean time to arousal was 3.8±2.8 days, with a range of 0.5-14.5 days. The mean time to arousal for a patient discharged in good neurological condition was 3.2±1.6 days versus 6.8±4.8 days for those who survived to discharge but did not have a good neurological outcome (p<0.01). There was no significant association between age, gender, race, or number of days on a paralytic, if a paralytic was used, and time to arousal. However, there was a significant association between prolonged time to arousal and renal insufficiency before arrest (p=0.03), initial nonshockable arrest rhythm (p=0.01), and lack of paralytic use (p<0.01).
Conclusions: Time to arousal after resuscitation and TH use is highly variable, and often longer than 3 days. Earlier arousal is associated with better neurologic status on hospital discharge. Time to arousal is prolonged in patients with renal insufficiency. Further research is required to determine optimal timing of neuroprognostication in the post-arrest setting.
- © 2011 by American Heart Association, Inc.