Late Awakening Is Common in Settings Without Withdrawal of Life-Sustaining Therapy in Out-of-Hospital Cardiac Arrest Survivors Who Undergo Targeted Temperature Management.
Aged
Cohort Studies
Female
Humans
Hypothermia, Induced
/ methods
Intensive Care Units
/ organization & administration
Male
Middle Aged
Out-of-Hospital Cardiac Arrest
/ complications
Republic of Korea
/ epidemiology
Retrospective Studies
Statistics, Nonparametric
Survivors
/ statistics & numerical data
Time Factors
Withholding Treatment
/ statistics & numerical data
Journal
Critical care medicine
ISSN: 1530-0293
Titre abrégé: Crit Care Med
Pays: United States
ID NLM: 0355501
Informations de publication
Date de publication:
01 02 2022
01 02 2022
Historique:
pubmed:
16
9
2021
medline:
1
3
2022
entrez:
15
9
2021
Statut:
ppublish
Résumé
We investigated awakening time and characteristics of awakening compared nonawakening and factors contributing to poor neurologic outcomes in out-of-hospital cardiac arrest survivors in no withdrawal of life-sustaining therapy settings. Retrospective analysis of the Korean Hypothermia Network Pro registry. Multicenter ICU. Adult (≥ 18 yr) comatose out-of-hospital cardiac arrest survivors who underwent targeted temperature management at 33-36°C between October 2015 and December 2018. None. We measured the time from the end of rewarming to awakening, defined as a total Glasgow Coma Scale score greater than or equal to 9 or Glasgow Coma Scale motor score equals to 6. The primary outcome was awakening time. The secondary outcome was 6-month neurologic outcomes (poor outcome: Cerebral Performance Category 3-5). Among 1,145 out-of-hospital cardiac arrest survivors, 477 patients (41.7%) regained consciousness 30 hours (6-71 hr) later, and 116 patients (24.3%) awakened late (72 hr after the end of rewarming). Young age, witnessed arrest, shockable rhythm, cardiac etiology, shorter time to return of spontaneous circulation, lower serum lactate level, absence of seizures, and multisedative requirement were associated with awakening. Of the 477 who woke up, 74 (15.5%) had poor neurologic outcomes. Older age, liver cirrhosis, nonshockable rhythm, noncardiac etiology, a higher Sequential Organ Failure Assessment score, and higher serum lactate levels were associated with poor neurologic outcomes. Late awakeners were more common in the poor than in the good neurologic outcome group (38/74 [51.4%] vs 78/403 [19.4%]; p < 0.001). The awakening time (odds ratio, 1.005; 95% CIs, 1.003-1.008) and late awakening (odds ratio, 3.194; 95% CIs, 1.776-5.746) were independently associated with poor neurologic outcomes. Late awakening after out-of-hospital cardiac arrest was common in no withdrawal of life-sustaining therapy settings and the probability of awakening decreased over time.
Identifiants
pubmed: 34524155
doi: 10.1097/CCM.0000000000005274
pii: 00003246-202202000-00008
doi:
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
235-244Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2021 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
Déclaration de conflit d'intérêts
The authors have disclosed that they do not have any potential conflicts of interest.
Références
Virani SS, Alonso A, Benjamin EJ, et al.; American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee: Heart disease and stroke statistics-2020 update: A report from the American Heart Association. Circulation. 2020; 141:e139–e596
Callaway CW, Schmicker RH, Brown SP, et al.; ROC Investigators: Early coronary angiography and induced hypothermia are associated with survival and functional recovery after out-of-hospital cardiac arrest. Resuscitation. 2014; 85:657–663
Elmer J, Torres C, Aufderheide TP, et al.; Resuscitation Outcomes Consortium: Association of early withdrawal of life-sustaining therapy for perceived neurological prognosis with mortality after cardiac arrest. Resuscitation. 2016; 102:127–135
Grossestreuer AV, Gaieski DF, Abella BS, et al.: Factors associated with post-arrest withdrawal of life-sustaining therapy. Resuscitation. 2017; 110:114–119
Panchal AR, Bartos JA, Cabañas JG, et al.; Adult Basic and Advanced Life Support Writing Group: Part 3: Adult basic and advanced life support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2020; 142:S366–S468
Grossestreuer AV, Abella BS, Leary M, et al.: Time to awakening and neurologic outcome in therapeutic hypothermia-treated cardiac arrest patients. Resuscitation. 2013; 84:1741–1746
Ponz I, Lopez-de-Sa E, Armada E, et al.: Influence of the temperature on the moment of awakening in patients treated with therapeutic hypothermia after cardiac arrest. Resuscitation. 2016; 103:32–36
Paul M, Bougouin W, Geri G, et al.: Delayed awakening after cardiac arrest: Prevalence and risk factors in the Parisian registry. Intensive Care Med. 2016; 42:1128–1136
Gold B, Puertas L, Davis SP, et al.: Awakening after cardiac arrest and post resuscitation hypothermia: Are we pulling the plug too early? Resuscitation. 2014; 85:211–214
Irisawa T, Vadeboncoeur TF, Karamooz M, et al.: Duration of coma in out-of-hospital cardiac arrest survivors treated with targeted temperature management. Ann Emerg Med. 2017; 69:36–43
Mulder M, Gibbs HG, Smith SW, et al.: Awakening and withdrawal of life-sustaining treatment in cardiac arrest survivors treated with therapeutic hypothermia*. Crit Care Med. 2014; 42:2493–2499
Lybeck A, Cronberg T, Aneman A, et al.; TTM-trial investigators: Time to awakening after cardiac arrest and the association with target temperature management. Resuscitation. 2018; 126:166–171
Rey A, Rossetti AO, Miroz JP, et al.: Late awakening in survivors of postanoxic coma: Early neurophysiologic predictors and association with ICU and long-term neurologic recovery. Crit Care Med. 2019; 47:85–92
Fugate JE, Wijdicks EF, White RD, et al.: Does therapeutic hypothermia affect time to awakening in cardiac arrest survivors? Neurology. 2011; 77:1346–1350
Zanyk-McLean K, Sawyer KN, Paternoster R, et al.: Time to awakening is often delayed in patients who receive targeted temperature management after cardiac arrest. Ther Hypothermia Temp Manag. 2017; 7:95–100
Eid SM, Albaeni A, Vaidya D, et al.: Awakening following cardiac arrest: Determined by the definitions used or the therapies delivered? Resuscitation. 2016; 100:38–44
Kim SH, Park KN, Youn CS, et al.; Korean Hypothermia Network investigators: Outcome and status of postcardiac arrest care in Korea: Results from the Korean Hypothermia Network prospective registry. Clin Exp Emerg Med. 2020; 7:250–258
World Medical Association: World Medical Association Declaration of Helsinki: Ethical principles for medical research involving human subjects. JAMA. 2013; 310:2191–2194
Booth CM, Boone RH, Tomlinson G, et al.: Is this patient dead, vegetative, or severely neurologically impaired? Assessing outcome for comatose survivors of cardiac arrest. JAMA. 2004; 291:870–879
Jones AE, Trzeciak S, Kline JA: The Sequential Organ Failure Assessment score for predicting outcome in patients with severe sepsis and evidence of hypoperfusion at the time of emergency department presentation. Crit Care Med. 2009; 37:1649–1654
Hochman JS, Sleeper LA, Webb JG, et al.: Early revascularization in acute myocardial infarction complicated by cardiogenic shock. SHOCK Investigators. Should we emergently revascularize occluded coronaries for cardiogenic shock. N Engl J Med. 1999; 341:625–634
Geocadin RG, Callaway CW, Fink EL, et al.; American Heart Association Emergency Cardiovascular Care Committee: Standards for studies of neurological prognostication in comatose survivors of cardiac arrest: A scientific statement from the American Heart Association. Circulation. 2019; 140:e517–e542
Martinell L, Nielsen N, Herlitz J, et al.: Early predictors of poor outcome after out-of-hospital cardiac arrest. Crit Care. 2017; 21:96
Nair SU, Lundbye JB: The occurrence of shivering in cardiac arrest survivors undergoing therapeutic hypothermia is associated with a good neurologic outcome. Resuscitation. 2013; 84:626–629
Elmer J, Coppler PJ, Solanki P, et al.: Sensitivity of continuous electroencephalography to detect ictal activity after cardiac arrest. JAMA Netw Open. 2020; 3:e203751