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Withdrawal of care may occur too soon in cardiac arrest patients who receive hypothermia treatment
Date:11/14/2011

(ORLANDO) -- Physicians may be making premature predictions about which patients are not likely to survive following cardiac arrest and even withdrawing care -- before the window in which comatose patients who have received therapeutic hypothermia are most likely to wake up, according to two new studies from the Perelman School of Medicine at the University of Pennsylvania. The research helps to better define the proper timeframe and manner in which doctors may be able to predict which patients will regain consciousness after the use of therapeutic hypothermia, which preserves brain and other organ function following cardiac arrest.

Patients treated with hypothermia often don't regain consciousness until three or more days after their cardiac arrest, according Penn research that will present today at the American Heart Association's annual Scientific Sessions (Abstract #10778. But in a separate Penn study published online this week in Critical Care Medicine, a chart review found that documentation of "poor" or "grave" prognosis occurred early on in 57 percent of cardiac arrest patients' treatment with hypothermia, with a quarter of those patients' care being withdrawn within 72 hours after their arrest. More than 20 percent of those patients whose doctors predicted they would die or suffer severe brain damage actually survived to discharge with a good neurological outcome, meaning they had mild or moderate cognitive deficits, but were able to live independently and often, resume their work and family responsibilities.

"Hypothermia improves survival after cardiac arrest, but it's changing our assumptions about how and when we should talk about withdrawing life support," said David Gaieski, MD, an assistant professor of Emergency Medicine, who led the research that will be presented at the AHA Scientific Sessions. "In the therapeutic hypothermia era, the timeframe for neuroprognostication needs to be prolonged, with decisions about withdraw
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Contact: Holly Auer
holly.auer@uphs.upenn.edu
215-200-2313
University of Pennsylvania School of Medicine
Source:Eurekalert

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