Predictors of poor neurologic outcome in patients undergoing therapeutic hypothermia after cardiac arrest.
BACKGROUND
Therapeutic hypothermia (TH) has been shown to reduce the degree of anoxic brain injury, decrease mortality, and improve neurologic recovery in patients surviving cardiac arrest. However, there is a paucity of data on potential markers of neurologic outcome that physicians can use in this setting.


METHODS
A retrospective medical records review of 41 consecutive survivors of cardiac arrest treated with TH (2004-08) was examined.


RESULTS
Mean patient age was 66 years old. Most subjects had an out-of-hospital, witnessed cardiac arrest, and two-thirds had received bystander cardiopulmonary resuscitation (CPR). About half of the patients had nonventricular tachycardia/fibrillation (VT/VF) arrests. Fifty-nine percent (24 of 41 subjects) died or experienced severe neurologic impairment. By bivariate analysis, factors associated with a poor neurologic prognosis included: 1) a first rhythm at cardiac arrest other than VT/VF (P = 0.01); 2) the presence of acute kidney injury (AKI) in the intensive care unit (ICU) (P < 0.001); 3) any treated cardiac arrhythmia after admission (P = 0.05); and 4) a Glasgow Coma Score <8 determined 12 hours after rewarming (P < 0.001). Using multiple regression analysis, non-VT/VF arrest, AKI, and cardiac arrhythmia remained significant risk factors for poor neurologic recovery. The cumulative risk of death or poor neurologic outcome increased with the presence of two or more risk factors.


CONCLUSIONS
Several simple, reproducible clinical markers can help predict neurologic recovery, during and after treatment, in patients managed with TH for cardiac arrest.
Department of Palliative Medicine, Scranton Temple Residency Training Program, Mercy Hospital, The Commonwealth Medical College, Scranton, PA 18510, USA.
Vincent J
VJ
Vanston
Mary
M
Lawhon-Triano
Roger
R
Getts
John
J
Prior
Raymond A
RA
Smego
D058186:Acute Kidney Injury / Q000150:complications; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000150:complications; D016887:Cardiopulmonary Resuscitation; D005260:Female; D015600:Glasgow Coma Scale; D006323:Heart Arrest / Q000150:complications* / Q000628:therapy*; D006801:Humans; D007036:Hypothermia, Induced; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000175:diagnosis* / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult