Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2015 Sep 11;3(1):38.
doi: 10.1186/s40560-015-0104-5. eCollection 2015.

At what level of unconsciousness is mild therapeutic hypothermia indicated for out-of-hospital cardiac arrest: a retrospective, historical cohort study

Tomoaki Natsukawa  1 , Hirotaka Sawano  1 , Mai Natsukawa  1 , Yuichi Yoshinaga  1 , Shuho Sato  1 , Yusuke Ito  1 , Takayuki Otani  1 , Jiro Ohba  1 , Yasuyuki Hayashi  1 , Tatsuro Kai  1
Affiliations

At what level of unconsciousness is mild therapeutic hypothermia indicated for out-of-hospital cardiac arrest: a retrospective, historical cohort study

Tomoaki Natsukawa et al. J Intensive Care. .

Abstract

Background: Appropriate patient selection is very important when initiating mild therapeutic hypothermia (MTH) for patients following out-of-hospital cardiac arrest, and the extent of unconsciousness at implementation must be defined in such cases. However, there are no clear standards regarding the level of unconsciousness at which MTH would be beneficial. The effects of MTH in patients with different degrees of unconsciousness according to the motor response score of the Glasgow Coma Scale (GCS) were investigated.

Methods: The subjects consisted of witnessed non-traumatic adult out-of-hospital cardiac arrest patients admitted to our institute from April 2002 to August 2011. The patients were divided into six groups according to the GCS motor response score: 1 (GCS M1), 2 (GCS M2), 3 (GCS M3), 4 (GCS M4), 5 (GCS M5), and 6 (GCS M6). The neurological outcome was evaluated at 30 days after hospital admission using the Cerebral Performance Category. Chi-squared Automatic Interaction Detection (CHAID) analysis was performed to estimate the threshold GCS M level where therapeutic hypothermia is indicated. Odds ratios were then calculated by multiple logistic-regression analysis using factors including GCS M5-6 and MTH.

Results: A total of 289 patients were enrolled in this study. CHAID analysis demonstrated two points of significant increase in percentage of good recovery at 30 days after admission, dividing the GCS M categories into three groups. Patients classified with a GCS motor response score of 5 or higher had the highest percentage of good recovery. The odds ratio for good recovery (CPC1-2) was 2.901 (95 % CI 1.460-5.763, P = 0.002) for MTH, and that for GCS M5-6 was 159.835 (95 % CI 33.592-760.513, P < 0.001).

Conclusions: MTH may be unnecessary in patients with a GCS motor response score of 5 or higher. Consequently, because there are post cardiac arrest patients with a GCS motor response score of 4 or lower who benefit from MTH, MTH may be limited to patients with a GCS motor response score of 4 or lower.

Keywords: Coma; Glasgow Coma Scale; Mild therapeutic hypothermia; Motor response score; Post cardiac arrest.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Flow chart of patient selection. ICU intensive care unit, GCS M1 patients classified with a GCS motor response score of 1, GCS M2 patients classified with a GCS motor response score of 2, GCS M3 patients classified with a GCS motor response score of 3, GCS M4 patients classified with a GCS motor response score of 4, GCS M5 patients classified with a GCS motor response score of 5, GCS M6 patients classified with a GCS motor response score of 6, MTH+ patients who were treated with mild therapeutic hypothermia, MTH− patients who were treated without mild therapeutic hypothermia
Fig. 2
Fig. 2
Chi-squared Automatic Interaction Detection classification tree for good recovery at 30 days after hospital admission. GCS M1 patients classified with a GCS motor response score of 1, GCS M2–4 patients classified with a GCS motor response score from 2 to 4, GCS M5–6 patients classified with a GCS motor response score of 5 or higher
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Peberdy M, Callaway C, Neumar R, Geocadin R, Zimmerman J, Donnino M, et al. American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Part 9 post-cardiac arrest care. Circulation. 2010;122:S768–S786. - PubMed
    1. Erb JL, Hravnak M, Rittenberger JC. Therapeutic hypothermia after cardiac arrest. Am J Nurs. 2012;112:38–44. doi: 10.1097/01.NAJ.0000415959.85050.1a. - DOI - PubMed
    1. Teasdale G, Maas A, Lecky F, Manley G, Stocchetti N, Murray G. The Glasgow Coma Scale at 40 years: standing the test of time. Lancet Neurol. 2014;13:844–54. doi: 10.1016/S1474-4422(14)70120-6. - DOI - PubMed
    1. Phelps R, Dumas F, Maynard C, Silver J, Rea T. Cerebral performance category and long-term prognosis following out-of-hospital cardiac arrest. Crit Care Med. 2013;41:1252–7. doi: 10.1097/CCM.0b013e31827ca975. - DOI - PubMed
    1. McKean S. Induced moderate hypothermia after cardiac arrest. AACN Adv Crit Care. 2009;20:343–55. doi: 10.1097/NCI.0b013e3181bcea4e. - DOI - PubMed

LinkOut - more resources