Abstract 12163: Pre-existing Medical Comorbidity is not Associated With Neurological Outcomes in Comatose Survivors of Cardiac Arrest Undergoing Targeted Temperature Management
Introduction: Evidence regarding the significance of pre-existing medical comorbidity in comatose survivors of cardiac arrest who undergo targeted temperature management (TTM) remains limited.
Hypothesis: Increasing burden of medical comorbidity will predict poor neurological outcomes following TTM.
Methods: We analyzed a prospectively collected cohort of 314 consecutive comatose survivors of cardiac arrest treated with TTM at a tertiary care hospital between 2007 and 2014. Overall burden of medical comorbidity was estimated with the use of the Charlson Comorbidity Index (CCI). Poor neurological outcome at hospital discharge, defined as a Cerebral Performance Category (CPC) score >2, was the primary outcome. Secondary outcomes included death prior to hospital discharge and at 1 year following cardiac arrest.
Results: Amongst all patients, the median CCI score was 1 (IQR 0-3, range 0-11). A poor neurological outcome at hospital discharge was observed in 193 (61%) patients. One hundred and seventy-nine (57%) patients died prior to hospital discharge and a total of 195 (62%) patients had died at 1 year post-arrest. In multivariable logistic regression, elevated CCI scores were not associated with increased odds of poor neurological outcomes (OR 1.04, 95% CI 0.90-1.19, p=0.608) or death (OR 0.99, 95% CI 0.86-1.13, p=0.816) at hospital discharge. No association was seen between CCI scores and death at 1 year post-arrest (OR 1.09, 95% CI 0.95-1.26, p=0.220), Table 1.
Conclusions: Increasing burden of medical comorbidity is not associated with neurological outcomes or survival in patients treated with TTM. Pre-existing comorbidity should not affect a patient’s candidacy for this treatment.
Table 1. Adjusted odds ratios of poor neurological outcomes and death.
CCI, Charlson Comorbidity Index; CI, confidence interval; CPR, cardiopulmonary resuscitation; OR, odds ratio; ROSC, return of spontaneous circulation; TTM, targeted temperature management.
Author Disclosures: A. Nayeri: None. N. Bhatia: None. B. Holmes: None. N. Borges: None. W. Armstrong: None. M. Young: None. Q. Wells: None. J. McPherson: None.
- © 2016 by American Heart Association, Inc.