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

al of care delayed until several days after the cardiac arrest -- at the earliest. Patients benefit from being managed by multidisciplinary teams that include experts in resuscitation as well as cardiologists, intensivists, and neurologists."

His study found that time to arousal following resuscitation and therapeutic hypothermia is highly variable and often longer than three days. Of 154 patients studied in three hospitals over a five-year period, the researchers found that 42 percent of patients studied survived to discharge from the hospital. Seventy two percent of those patients had a good neurological outcome. The mean time to arousal, which the researchers defined as the point at which the patient began following commands purposefully, was 3.8 days, with a range of 0.5 to 14.5 days. Even among those who were discharged in good neurological condition, the mean time to arousal was 3.2 days, indicating that efforts to predict a patient's outcome early during cooling are not likely to be effective. The study found that patients who had kidney problems prior to their arrest, had an initial heart rhythm that could not be shocked back to normalcy, and who did not receive paralytic drugs during their treatment were more likely to take longer to regain consciousness.

In an effort to better determine which tests might help pinpoint which patients may survive with fewer cognitive impairments, Merchant's team also studied the use of head CT, electroencephalography, and somatosensory evoked potential testing following arrest in the cases they examined. Although at least one of these tests were commonly used, they were used at a variety of different points following arrest, and are known to be less precise when the body temperature is below normal, partly because drugs that can impact test results accumulate in the body under those conditions. In addition, the researchers note that prognostication while a patient is paralyzed and sedated necessary during
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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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