title: Therapeutic hypothermia after cardiac arrest: outcome predictors.
abstract: OBJECTIVE
  The determination of coma patient prognosis after cardiac arrest has clinical, ethical and social implications. Neurological examination, imaging and biochemical markers are helpful tools accepted as reliable in predicting recovery. With the advent of therapeutic hypothermia, these data need to be reconfirmed. In this study, we attempted to determine the validity of different markers, which can be used in the detection of patients with poor prognosis under hypothermia.
  
  
  METHODS
  Data from adult patients admitted to our intensive care unit for a hypothermia protocol after cardiac arrest were recorded prospectively to generate a descriptive and analytical study analyzing the relationship between clinical, neurophysiological, imaging and biochemical parameters with 6-month outcomes defined according to the Cerebral Performance Categories scale (good 1-2, poor 3-5). Neuron-specific enolase was collected at 72 hours. Imaging and neurophysiologic exams were carried out in the 24 hours after the rewarming period.
  
  
  RESULTS
  Sixty-seven patients were included in the study, of which 12 had good neurological outcomes. Ventricular fibrillation and electroencephalographic theta activity were associated with increased likelihood of survival and improved neurological outcomes. Patients who had more rapid cooling (mean time of 163 versus 312 minutes), hypoxic-ischemic brain injury on magnetic resonance imaging or neuron-specific enolase > 58ng/mL had poor neurological outcomes (p < 0.05).
  
  
  CONCLUSIONS
  Hypoxic-ischemic brain injury on magnetic resonance imaging and neuron-specific enolase were strong predictors of poor neurological outcomes. Although there is the belief that early achievement of target temperature improves neurological prognoses, in our study, there were increased mortality and worse neurological outcomes with earlier target-temperature achievement.
authors.affiliation: Unidade de Urgência Médica, Centro Hospitalar de Lisboa Central, Lisboa, Portugal.
authors.forename: Rodrigo Nazário
authors.initials: RN
authors.lastname: Leão
authors.affiliation: Unidade de Urgência Médica, Centro Hospitalar de Lisboa Central, Lisboa, Portugal.
authors.forename: Paulo
authors.initials: P
authors.lastname: Ávila
authors.affiliation: Unidade de Urgência Médica, Centro Hospitalar de Lisboa Central, Lisboa, Portugal.
authors.forename: Raquel
authors.initials: R
authors.lastname: Cavaco
authors.affiliation: Unidade de Urgência Médica, Centro Hospitalar de Lisboa Central, Lisboa, Portugal.
authors.forename: Nuno
authors.initials: N
authors.lastname: Germano
authors.affiliation: Unidade de Urgência Médica, Centro Hospitalar de Lisboa Central, Lisboa, Portugal.
authors.forename: Luís
authors.initials: L
authors.lastname: Bento
mesh_terms: D000368:Aged; D003128:Coma / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006323:Heart Arrest / Q000150:complications / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D020925:Hypoxia-Ischemia, Brain / Q000209:etiology* / Q000401:mortality; D007362:Intensive Care Units; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010751:Phosphopyruvate Hydratase / Q000378:metabolism; D011379:Prognosis; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D010751:Phosphopyruvate Hydratase