title: Methylphenidate and amantadine to stimulate reawakening in comatose patients resuscitated from cardiac arrest.
abstract: BACKGROUND
  Despite critical-care packages including therapeutic hypothermia (TH), neurologic injury is common after cardiac arrest (CA) resuscitation. Methylphenidate and amantadine have treated coma in traumatically-brain-injured patients with mixed success, but have not been explored in post-arrest patients.
  
  
  OBJECTIVE
  Compare the outcome of comatose post-arrest patients treated with neurostimulants to a matched cohort.
  
  
  METHODS
  Retrospective cohort study from 6/2008 to 12/2011 in a tertiary university hospital. We included adult patients treated with methylphenidate or amantadine after resuscitation from in-hospital or out-of-hospital CA (OHCA) of any rhythm, excluding patients with traumatic/surgical etiology of arrest, terminal re-arrest within 6h, or withdrawal of care by family within 6h. Primary outcome was following commands; secondary outcomes included survival to hospital discharge, cerebral performance category (CPC), and modified Rankin scale (mRS). We compared characteristics and outcomes to a control cohort matched on TH and 72 h FOUR score ± 1.
  
  
  RESULTS
  Of 588 patients, 8 received methylphenidate, 6 received amantadine, and 2 both. Most were female suffering OHCA with median age 61 years. All received TH and a multi-modal neurological evaluation. Initial exam revealed median GCS 6 and FOUR 7, which was unchanged at 72 h. Six patients (38%) followed commands prior to discharge at median 2.5 days (range: 1-18 days) after treatment. Patients receiving neurostimulants trended toward improved rate of following commands, survival to hospital discharge, and distribution of CPC and mRS scores.
  
  
  CONCLUSIONS
  Neurostimulants may be considered to stimulate wakefulness in selected post-cardiac arrest patients, but a prospective trial is needed to evaluate this therapy.
authors.affiliation: Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA. reynoldsjc@upmc.edu
authors.forename: Joshua C
authors.initials: JC
authors.lastname: Reynolds
authors.forename: Jon C
authors.initials: JC
authors.lastname: Rittenberger
authors.forename: Clifton W
authors.initials: CW
authors.lastname: Callaway
mesh_terms: D000328:Adult; D000368:Aged; D000547:Amantadine / Q000627:therapeutic use*; D016887:Cardiopulmonary Resuscitation; D000697:Central Nervous System Stimulants / Q000627:therapeutic use*; D015331:Cohort Studies; D003128:Coma / Q000188:drug therapy* / Q000209:etiology / Q000628:therapy; D005260:Female; D006323:Heart Arrest / Q000150:complications / Q000188:drug therapy* / Q000628:therapy; D006801:Humans; D008297:Male; D008774:Methylphenidate / Q000627:therapeutic use*; D008875:Middle Aged; D010351:Patient Discharge; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000697:Central Nervous System Stimulants; D008774:Methylphenidate; D000547:Amantadine