Abstract 75: Time to Awakening Is Often Delayed After Therapeutic Hypothermia for Post--Cardiac Arrest Patients
Introduction Withdrawal of care in patients after cardiac arrest has traditionally been based on the neurological exam at 72 hours after hospital arrival. For patients receiving post-cardiac arrest therapeutic hypothermia (TH), however, there is limited data to guide prognostication. We sought to describe the time to awakening for patients treated with TH and the relationships between time to awakening and outcome.
Methods We performed a retrospective chart review of adult (age > 18) cardiac arrest patients from January 2006 to January 2012 who were subsequently treated with TH at a large, academic community hospital. We abstracted demographic data, neurological assessments recorded by ICU nurses, including Glasgow Coma Scale (GCS), and survival data, including cerebral performance category (CPC) at discharge. We abstracted time intervals including intervals from arrival to target temperature (33.5°), interval to rewarming (35°C), and interval from arrival and rewarming to awakening. We defined awakening as GCS greater than 8, or GCS motor >4 for intubated patients. Our primary outcome measure was good neurological outcome at discharge (CPC of 1 or 2). Descriptive statistics are reported.
Results During the study period, 96 patients received TH (average age 60.3 years, 64.2% male). Overall, 39 (40.6%) patients survived to discharge, six were excluded (five did not awaken, one missing time data). Time (median, IQR) from ED arrival to rewarming was 41.0 (39,43) hours, ED arrival to awakening was 52.8 (43, 89) hours, and awakening to rewarming was 12.0 (2, 42) hours. The relationship between awakening and outcome is shown in table 1.
Conclusion Although most patients with a good outcome awoke within 72 hours of hospital arrival or shortly after rewarming, a number of patients had awakening delayed more than 72 hours post arrival and rewarming. Our results support the need for longer periods of observation to determine outcomes for patients who receive post arrest TH.
- © 2012 by American Heart Association, Inc.