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Early coronary angiography is associated with improved functional outcome among resuscitated patients with and without STEMI. Resuscitated patients with a presumed cardiac etiology appear to benefit from immediate coronary angiography.

Objective To determine if higher levels of partial pressure of arterial oxygen are associated with in-hospital mortality and poor neurologic status at hospital discharge in patients treated with mild therapeutic hypothermia after sudden cardiac arrest. Design Retrospective analysis of a prospective cohort study Patients A total of 170 consecutive patients treated with therapeutic hypothermia in the cardiovascular care unit of an academic tertiary care hospital. Interventions None. Measurements and Main Results Of 170 patients, 77 (45.2%) survived to hospital discharge. Survivors had a significantly lower maximum partial pressure of arterial oxygen(198 mmHg, IQR 152.5–282) measured in the first 24 hours following cardiac arrest compared to nonsurvivors (254 mmHg, IQR 172–363, p = .022). A multivariable analysis including age, time to return of spontaneous circulation, the presence of shock, bystander CPR, and initial rhythm revealed that higher levels of the partial pressure of arterial oxygen were significantly associated with increased in-hospital mortality (odds ratio 1.439, 95% confidence interval 1.028–2.015, p = 0.034) and poor neurologic status at hospital discharge (odds ratio 1.485, 95% confidence interval 1.032–2.136, p = 0.033). Conclusions Higher levels of the maximum measured partial pressure of arterial oxygen are associated with increased in-hospital mortality and poor neurologic status on hospital discharge in patients treated with mild therapeutic hypothermia after sudden cardiac arrest.

Introduction To determine if higher achieved mean arterial blood pressure (MAP) during treatment with therapeutic hypothermia (TH) is associated with neurologically intact survival following cardiac arrest. Methods Retrospective analysis of a prospectively collected cohort of 188 consecutive patients treated with TH in the cardiovascular intensive care unit of an academic tertiary care hospital. Results Neurologically intact survival was observed in 73/188 (38.8%) patients at hospital discharge and in 48/162 (29.6%) patients at a median follow up interval of 3 months. Patients in shock at the time of admission had lower baseline MAP at the initiation of TH (81 versus 87 mmHg; p=0.002), but had similar achieved MAP during TH (80.3 versus 83.7 mmHg; p=0.11). Shock on admission was associated with poor survival (18% versus 52%; p<0.001). Vasopressor use among all patients was common (84.6%) and was not associated with increased mortality. A multivariable analysis including age, initial rhythm, time to return of spontaneous circulation, baseline MAP and achieved MAP did not demonstrate a relationship between MAP achieved during TH and poor neurologic outcome at hospital discharge (OR 1.28, 95% CI 0.40–4.06; p=0.87) or at outpatient follow up (OR 1.09, 95% CI 0.32–3.75; p=0.976). Conclusion We did not observe a relationship between higher achieved MAP during TH and neurologically intact survival. However, shock at the time of admission was clearly associated with poor outcomes in our study population. These data do not support the use of vasopressors to artificially increase MAP in the absence of shock. There is a need for prospective, randomized trials to further define the optimum blood pressure target during treatment with TH.

Objective To test the hypothesis that low bispectral index (BIS) scores and low sedative requirements during therapeutic hypothermia predict poor neurologic outcome. Design, Setting, and Patients Observational study of a prospectively collected cohort of 160 consecutive cardiac arrest patients treated with therapeutic hypothermia. Interventions None Measurements and Results Eighty-four (60%) of the 141 subjects that survived hypothermia induction were discharged from the ICU with poor neurologic outcome, defined as a cerebral performance category (CPC) score of 3, 4, or 5. These subjects had lower BIS (p<0.001) and sedative requirements (p<0.001) during hypothermia compared to the 57 subjects discharged with good outcome. Early prediction of neurologic recovery was best seven hours after ICU admission, and median BIS scores at that time were 31 points lower in subjects discharged with poor outcome [11 (IQR 4 to 29) vs. 42 (37 to 49), p<0.001]. Median sedation requirements decreased by 17% (IQR −50% to 0%) seven hours after ICU admission in subjects with poor outcome but increased by 50% (95% CI 0% to 142%) in subjects with good outcome (p<0.001). Each 10-point decrease in BIS was independently associated with a 59% increase in the odds of poor outcome (95% CI: 32% to 76%, p<0.001). The model including BIS and sedative requirement correctly reclassified 15% of subjects from good to poor outcome and 1% of subjects from poor to good outcome. The model incorrectly reclassified 1% of subjects from poor to good outcome but did not incorrectly reclassify any from good to poor outcome. Conclusions BIS scores and sedative requirements early in the course of therapeutic hypothermia improve the identification of patients who will not recover from brain anoxia. The ability to accurately predict non-recovery after cardiac arrest could facilitate discussions with families, reduce patient suffering, and limit use of ICU resources in futile cases.