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Observational Study
. 2014 Aug;85(8):1042-6.
doi: 10.1016/j.resuscitation.2014.04.005. Epub 2014 Apr 16.

Neurologic outcome in comatose patients resuscitated from out-of-hospital cardiac arrest with prolonged downtime and treated with therapeutic hypothermia

Won Young Kim  1 , Tyler A Giberson  2 , Amy Uber  2 , Katherine Berg  3 , Michael N Cocchi  4 , Michael W Donnino  5
Affiliations
Observational Study

Neurologic outcome in comatose patients resuscitated from out-of-hospital cardiac arrest with prolonged downtime and treated with therapeutic hypothermia

Won Young Kim et al. Resuscitation. 2014 Aug.

Abstract

Background: Previous reports have shown that prolonged duration of resuscitation efforts in out-of-hospital cardiac arrest (OHCA) is associated with poor neurologic outcome. This concept has recently been questioned with advancements in post-cardiac arrest care including the use of therapeutic hypothermia (TH). The aim of this study was to determine the rate of good neurologic outcome based on the duration of resuscitation efforts in OHCA patients treated with TH.

Methods: This prospective, observational, study was conducted between January 2008 and September 2012. Inclusion criteria consisted of adult non-traumatic OHCA patients who were comatose after return of spontaneous circulation (ROSC) and received TH. The primary endpoint was good neurologic outcome defined as a cerebral performance category score of 1 or 2. Downtime was calculated as the length of time between the patient being recognized as pulseless and ROSC.

Results: 105 patients were treated with TH and 19 were excluded due to unknown downtime, leaving 86 patients for analysis. The median downtime was 18.5 (10.0-32.3)min and 33 patients (38.0%) had a good neurologic outcome. When downtime was divided into four groups (≤10min, 11-20min, 21-30min, >30min), good neurologic outcomes were 62.5%, 37%, 25%, and 21.7%, respectively (p=0.02). However, even with downtime >20min, 22.9% had a good neurologic outcome, and this percentage increased to 37.5% in patients with an initial shockable rhythm.

Conclusions: Although longer downtime is associated with worse outcome in OHCA patients, we found that comatose patients who have been successfully resuscitated and treated with TH have neurologically intact survival rates of 23% even with downtime >20min.

Keywords: Out-of-hospital cardiac arrest; Outcome; Therapeutic hypothermia.

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Figures

Figure 1
Figure 1
Good neurologic outcome of the out-of-hospital cardiac arrest patients treated with hypothermia, stratified by initial rhythm and duration of downtime CPC, cerebral performance score, reported as median with interquartile range.
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References

    1. Hypothermia After Cardiac Arrest Study Group. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. The New England journal of medicine. 2002 Feb 21;346(8):549–556. - PubMed
    1. Bernard SA, Gray TW, Buist MD, et al. Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. The New England journal of medicine. 2002 Feb 21;346(8):557–563. - PubMed
    1. Cheung KW, Green RS, Magee KD. Systematic review of randomized controlled trials of therapeutic hypothermia as a neuroprotectant in post cardiac arrest patients. Cjem. 2006 Sep;8(5):329–337. - PubMed
    1. Holzer M, Bernard SA, Hachimi-Idrissi S, Roine RO, Sterz F, Mullner M. Hypothermia for neuroprotection after cardiac arrest: systematic review and individual patient data meta-analysis. Critical care medicine. 2005 Feb;33(2):414–418. - PubMed
    1. Sanders AB. Therapeutic hypothermia after cardiac arrest. Current opinion in critical care. 2006 Jun;12(3):213–217. - PubMed

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