INTRODUCTION: Therapeutic hypothermia (TH) has been shown to improve outcomes in comatose Post-Cardiac Arrest Syndrome (PCAS) patients. It is unclear how long it takes these patients to regain neurologic responsiveness post-arrest. We sought to determine the duration to post-arrest awakening and factors associated with times to such responsiveness. METHODS: We performed a retrospective chart review of consecutive TH-treated PCAS patients at three hospitals participating in a US cardiac arrest registry from 2005 to 2011. We measured the time from arrest until first documentation of "awakening", defined as following commands purposefully. RESULTS: We included 194 consecutive TH-treated PCAS patients; mean age was 57±16 years; 59% were male; 40% had an initial shockable rhythm. Mean cooling duration was 24±8h and mean rewarming time was 14±13h. Survival to discharge was 44%, with 78% of these discharged with a good neurologic outcome. Of the 85 patients who awakened, median time to awakening was 3.2 days (IQR 2.2, 4.5) post-cardiac arrest. Median time to awakening for a patient discharged in good neurological condition was 2.8 days (IQR 2.0, 4.5) vs. 4.0 days (IQR 3.5, 7.6) for those who survived to discharge without a good neurological outcome (p=0.035). There was no significant association between initial rhythm, renal insufficiency, paralytic use, post-arrest seizure, or location of arrest and time to awakening. CONCLUSION: In TH-treated PCAS patients, time to awakening after resuscitation was highly variable and often longer than three days. Earlier awakening was associated with better neurologic status at hospital discharge.
INTRODUCTION: Therapeutic hypothermia (TH) has been shown to improve outcomes in comatose Post-Cardiac Arrest Syndrome (PCAS) patients. It is unclear how long it takes these patients to regain neurologic responsiveness post-arrest. We sought to determine the duration to post-arrest awakening and factors associated with times to such responsiveness. METHODS: We performed a retrospective chart review of consecutive TH-treated PCAS patients at three hospitals participating in a US cardiac arrest registry from 2005 to 2011. We measured the time from arrest until first documentation of "awakening", defined as following commands purposefully. RESULTS: We included 194 consecutive TH-treated PCAS patients; mean age was 57±16 years; 59% were male; 40% had an initial shockable rhythm. Mean cooling duration was 24±8h and mean rewarming time was 14±13h. Survival to discharge was 44%, with 78% of these discharged with a good neurologic outcome. Of the 85 patients who awakened, median time to awakening was 3.2 days (IQR 2.2, 4.5) post-cardiac arrest. Median time to awakening for a patient discharged in good neurological condition was 2.8 days (IQR 2.0, 4.5) vs. 4.0 days (IQR 3.5, 7.6) for those who survived to discharge without a good neurological outcome (p=0.035). There was no significant association between initial rhythm, renal insufficiency, paralytic use, post-arrest seizure, or location of arrest and time to awakening. CONCLUSION: In TH-treated PCAS patients, time to awakening after resuscitation was highly variable and often longer than three days. Earlier awakening was associated with better neurologic status at hospital discharge.
Authors: Vimal Ramjee; Anne V Grossestreuer; Yuan Yao; Sarah M Perman; Marion Leary; James N Kirkpatrick; Paul R Forfia; Daniel M Kolansky; Benjamin S Abella; David F Gaieski Journal: Resuscitation Date: 2015-08-28 Impact factor: 5.262
Authors: Maximilian Mulder; Haley G Gibbs; Stephen W Smith; Ramnik Dhaliwal; Nathaniel L Scott; Mark D Sprenkle; Romergryko G Geocadin Journal: Crit Care Med Date: 2014-12 Impact factor: 7.598
Authors: Cindy H Hsu; Bryce E Haac; Mack Drake; Andrew C Bernard; Alberto Aiolfi; Kenji Inaba; Holly E Hinson; Chinar Agarwal; Joseph Galante; Emily M Tibbits; Nicholas J Johnson; David Carlbom; Mina F Mirhoseini; Mayur B Patel; Karen R OʼBosky; Christian Chan; Pascal O Udekwu; Megan Farrell; Jeffrey L Wild; Katelyn A Young; Daniel C Cullinane; Deborah J Gojmerac; Alexandra Weissman; Clifton Callaway; Sarah M Perman; Mariana Guerrero; Imoigele P Aisiku; Raghu R Seethala; Ivan N Co; Debbie Y Madhok; Bryan Darger; Dennis Y Kim; Lara Spence; Thomas M Scalea; Deborah M Stein Journal: J Trauma Acute Care Surg Date: 2018-07 Impact factor: 3.313
Authors: Yuan Yao; Nicholas James Johnson; Sarah Muirhead Perman; Vimal Ramjee; Anne Victoria Grossestreuer; David Foster Gaieski Journal: Intern Emerg Med Date: 2017-10-05 Impact factor: 3.397