Abstract 100: Length of Coma in Out-of-Hospital Cardiac Arrest Survivors Treated With Mild Therapeutic Hypothermia
Introduction: In the era of therapeutic hypothermia (TH), predicting neurologic outcome after out-of-hospital cardiac arrest (OHCA) is challenging. Guidelines on the appropriate timing of termination-of-care for comatose OHCA victims who undergo TH are lacking and practice varies widely. In a statewide effort, we examined the interval from completion of rewarming after TH to display of definitive signs of awakening in OHCA patients.
Method: A retrospective study of comatose adults( ≥18 years) after OHCA who presented to one of 34 designated Cardiac Receiving Centers (CRCs) participating in the Save Hearts in Arizona Registry and Education (SHARE) Program from 7/26/08-3/31/13. Inclusion criteria were OHCA, comatose on admission, treated with TH, and eventual response to verbal commands. Hospital records were reviewed to determine the time each patient displayed signs of return of neurologic function. Cerebral Performance Category (CPC) was measured for each survivor (discharged alive from hospital).
Results: A total of 193 OHCA survivors (mean age 57.7 ± 16.6, 69% male) were included. Times to awakening for all cases are shown in the figure. The majority, 135/193 (69.9%), awoke either during the rewarming phase, or within the first 24 hours after reaching normothermia. However, 28/193 (14.5%) awoke >72 hours after TH. Of these, 24/28 (85.7%) had good neurologic function at discharge (CPC 1-2), compared to 153/165 (92.7%) who awoke within 72 hours.
Conclusion: Within this statewide cohort of cardiac receiving centers, there is wide variability in time to awakening after OHCA in patients who receive TH. It is notable that a substantial number of patients awaken after 72 hours. These findings suggest that outcomes are not universally poor for patients with prolonged coma if they received TH. Further study is required to determine if prognostic factors can be identified to predict those patients who may benefit from ongoing care despite remaining in coma beyond 72 hours.
- © 2013 by American Heart Association, Inc.