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. 2011 Aug;15(1):113-9.
doi: 10.1007/s12028-010-9412-8.

Sedation confounds outcome prediction in cardiac arrest survivors treated with hypothermia

Edgar A Samaniego  1 , Michael Mlynash, Anna Finley Caulfield, Irina Eyngorn, Christine A C Wijman
Affiliations

Sedation confounds outcome prediction in cardiac arrest survivors treated with hypothermia

Edgar A Samaniego et al. Neurocrit Care. 2011 Aug.

Abstract

Background: Therapeutic hypothermia is commonly used in comatose survivors' post-cardiopulmonary resuscitation (CPR). It is unknown whether outcome predictors perform accurately after hypothermia treatment.

Methods: Post-CPR comatose survivors were prospectively enrolled. Six outcome predictors [pupillary and corneal reflexes, motor response to pain, and somatosensory-evoked potentials (SSEP) >72 h; status myoclonus, and serum neuron-specific enolase (NSE) levels <72 h] were systematically recorded. Poor outcome was defined as death or vegetative state at 3 months. Patients were considered "sedated" if they received any sedative drugs ≤ 12 h prior the 72 h neurological assessment.

Results: Of 85 prospectively enrolled patients, 53 (62%) underwent hypothermia. Furthermore, 53 of the 85 patients (62%) had a poor outcome. Baseline characteristics did not differ between the hypothermia and normothermia groups. Sedative drugs at 72 h were used in 62 (73%) patients overall, and more frequently in hypothermia than in normothermia patients: 83 versus 60% (P = 0.02). Status myoclonus <72 h, absent cortical responses by SSEPs >72 h, and absent pupillary reflexes >72 h predicted poor outcome with a 100% specificity both in hypothermia and normothermia patients. In contrast, absent corneal reflexes >72 h, motor response extensor or absent >72 h, and peak NSE >33 ng/ml <72 h predicted poor outcome with 100% specificity only in non-sedated patients, irrespective of prior treatment with hypothermia.

Conclusions: Sedative medications are commonly used in proximity of the 72-h neurological examination in comatose CPR survivors and are an important prognostication confounder. Patients treated with hypothermia are more likely to receive sedation than those who are not treated with hypothermia.

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Figures

Fig. 1
Fig. 1
Time course of the cooling phase and prognostication.
Fig. 2
Fig. 2
Poor outcome patients (N = 53). Fifty-two patients died: three patients progressed to brain death, six died of medical complications while on full support, and 43 patients were made comfort care. One patient remained in a vegetative state at 3 months
See this image and copyright information in PMC

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