Abstract 279: Time to Awakening After Cardiac Arrest: How Long Should We Wait?
Background: Studies performed prior to the use of therapeutic hypothermia (TH) suggest the optimal timeline for prognostication after cardiac arrest (CA) is on day 3 but this may not be generalizable to patients (pts) treated with TH. Current guidelines state that futility should not be declared until greater than day 3 after ROSC in hypothermic pts.
Purpose: To identify the time to awakening in post arrest patients treated with TH.
Methods: Post hoc analysis of a prospective, non-interventional, multi-center trial. Data from 111 consecutive pts from 7-1-11 thru 3-31-12 were analyzed using PASW v20. Results are presented as median [25th, 75th percentiles]. Time to awakening is defined as the number of calendar days from ROSC to purposefully following commands.
Results: Fifty-one of the 111 patients (46%) survived to discharge. Awakening occurred in 39/51 (77%) patients who survived to discharge vs. 1/60 (3%) who awakened and died. Median time to awakening in those who awakened and survived to discharge was 1 [.25, 2] day (range 0-28 days). It took 4.9 days for 90%, and 11.9 days for 95%, of those who awakened to do so. Characteristics of all patients and those who awakened and survived to discharge stratified by time of awakening after ROSC are shown in the Table.
Conclusions: Awakening and good neurological outcome occurs in pts treated with TH who remain comatose on day 3 after CA, irrespective of the first documented rhythm. Most patients who awaken will do so by the end of day 4, but 10% require longer. Our data suggest that it may be necessary to wait >3 days to allow adequate time for awakening after CA in patients treated with TH. Allowing patients adequate time for neurological recovery requires longer hospital stays and additional resources. Further study should prospectively evaluate the timeframe for expected neurological recovery in CA pts treated with TH.
- © 2012 by American Heart Association, Inc.