Delayed awakening after cardiac arrest: prevalence and risk factors in the Parisian registry

Paul, Marine; Bougouin, Wulfran; Géri, Guillaume; Dumas, Florence; Champigneulle, Benoît; Legriel, Stéphane; Charpentier, Julien; Mira, Jean Paul; Sandroni, Claudio; Cariou, Alain

doi:10.1007/s00134-016-4349-9

Cited by 119 publications

(96 citation statements)

References 40 publications

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“…Several studies have found that delayed awakening (>48 hours after cessation of sedation) is common in patients after cardiac arrest. 101 In a study of patients still in a coma 7 days after cardiac arrest, 22% obtained a favorable neurological outcome at 6 months. 102 The American Heart Association recommends that neuroprognostication based on physical examination findings should be deferred until at least 72 hours after return of spontaneous circulation or rewarming (if targeted temperature management is used), and often longer if effects of sedation or neuromuscular blockade may still be present.…”

Section: Resultsmentioning

confidence: 99%

In-Hospital Cardiac Arrest

Andersen

Holmberg

Berg

et al. 2019

JAMA

632

535

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IMPORTANCE In-hospital cardiac arrest is common and associated with a high mortality rate. Despite this, in-hospital cardiac arrest has received little attention compared with other high-risk cardiovascular conditions, such as stroke, myocardial infarction, and out-of-hospital cardiac arrest. OBSERVATIONS In-hospital cardiac arrest occurs in over 290 000 adults each year in the United States. Cohort data from the United States indicate that the mean age of patients with in-hospital cardiac arrest is 66 years, 58% are men, and the presenting rhythm is most often (81%) nonshockable (ie, asystole or pulseless electrical activity). The cause of the cardiac arrest is most often cardiac (50%-60%), followed by respiratory insufficiency (15%-40%). Efforts to prevent in-hospital cardiac arrest require both a system for identifying deteriorating patients and an appropriate interventional response (eg, rapid response teams). The key elements of treatment during cardiac arrest include chest compressions, ventilation, early defibrillation, when applicable, and immediate attention to potentially reversible causes, such as hyperkalemia or hypoxia. There is limited evidence to support more advanced treatments. Post–cardiac arrest care is focused on identification and treatment of the underlying cause, hemodynamic and respiratory support, and potentially employing neuroprotective strategies (eg, targeted temperature management). Although multiple individual factors are associated with outcomes (eg, age, initial rhythm, duration of the cardiac arrest), a multifaceted approach considering both potential for neurological recovery and ongoing multiorgan failure is warranted for prognostication and clinical decision-making in the Post–cardiac arrest period. Withdrawal of care in the absence of definite prognostic signs both during and after cardiac arrest should be avoided. Hospitals are encouraged to participate in national quality-improvement initiatives. CONCLUSIONS AND RELEVANCE An estimated 290 000 in-hospital cardiac arrests occur each year in the United States. However, there is limited evidence to support clinical decision making. An increased awareness with regard to optimizing clinical care and new research might improve outcomes.

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Section: Resultsmentioning

confidence: 99%

In-Hospital Cardiac Arrest

Andersen

Holmberg

Berg

et al. 2019

JAMA

632

535

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“…However, all centers consistently applied their local WLST protocol, which was based on ERC–ESICM prognostication guidelines [6, 34] or equivalent algorithms [25, 35]. These recommendations should be the benchmark of every current prognostication study.…”

Section: Discussionmentioning

confidence: 99%

Quantitative versus standard pupillary light reflex for early prognostication in comatose cardiac arrest patients: an international prospective multicenter double-blinded study

et al. 2018

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PurposeTo assess the ability of quantitative pupillometry [using the Neurological Pupil index (NPi)] to predict an unfavorable neurological outcome after cardiac arrest (CA).MethodsWe performed a prospective international multicenter study (10 centers) in adult comatose CA patients. Quantitative NPi and standard manual pupillary light reflex (sPLR)—blinded to clinicians and outcome assessors—were recorded in parallel from day 1 to 3 after CA. Primary study endpoint was to compare the value of NPi versus sPLR to predict 3-month Cerebral Performance Category (CPC), dichotomized as favorable (CPC 1–2: full recovery or moderate disability) versus unfavorable outcome (CPC 3–5: severe disability, vegetative state, or death).ResultsAt any time between day 1 and 3, an NPi ≤ 2 (n = 456 patients) had a 51% (95% CI 49–53) negative predictive value and a 100% positive predictive value [PPV; 0% (0–2) false-positive rate], with a 100% (98–100) specificity and 32% (27–38) sensitivity for the prediction of unfavorable outcome. Compared with NPi, sPLR had significantly lower PPV and significantly lower specificity (p < 0.001 at day 1 and 2; p = 0.06 at day 3). The combination of NPi ≤ 2 with bilaterally absent somatosensory evoked potentials (SSEP; n = 188 patients) provided higher sensitivity [58% (49–67) vs. 48% (39–57) for SSEP alone], with comparable specificity [100% (94–100)].ConclusionsQuantitative NPi had excellent ability to predict an unfavorable outcome from day 1 after CA, with no false positives, and significantly higher specificity than standard manual pupillary examination. The addition of NPi to SSEP increased sensitivity of outcome prediction, while maintaining 100% specificity.Electronic supplementary materialThe online version of this article (10.1007/s00134-018-5448-6) contains supplementary material, which is available to authorized users.

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“…As a result, there was a difference in baseline characteristics between ECLS and control patients. ECLS-treated patients were more likely to be male, younger, suffer from acute myocardial infarction and were more likely to undergo primary PCI—all factors known to be associated with increased survival in this setting [24–26]. Another potentially important bias towards poor outcomes in the ‘control/no-ECLS’ group may be due to the fact that sicker patients may have been considered too ill to benefit from ECLS therapy and others may have died before they could receive ECLS therapy.…”

Section: Discussionmentioning

confidence: 99%

Extracorporeal life support during cardiac arrest and cardiogenic shock: a systematic review and meta-analysis

et al. 2016

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PurposeVeno-arterial extracorporeal life support (ECLS) is increasingly used in patients during cardiac arrest and cardiogenic shock, to support both cardiac and pulmonary function. We performed a systematic review and meta-analysis of cohort studies comparing mortality in patients treated with and without ECLS support in the setting of refractory cardiac arrest and cardiogenic shock complicating acute myocardial infarction.MethodsWe systematically searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials and the publisher subset of PubMed updated to December 2015. Thirteen studies were included of which nine included cardiac arrest patients (n = 3098) and four included patients with cardiogenic shock after acute myocardial infarction (n = 235). Data were pooled by a Mantel-Haenzel random effects model and heterogeneity was examined by the I 2 statistic.ResultsIn cardiac arrest, the use of ECLS was associated with an absolute increase of 30 days survival of 13 % compared with patients in which ECLS was not used [95 % CI 6–20 %; p < 0.001; number needed to treat (NNT) 7.7] and a higher rate of favourable neurological outcome at 30 days (absolute risk difference 14 %; 95 % CI 7–20 %; p < 0.0001; NNT 7.1). Propensity matched analysis, including 5 studies and 438 patients (219 in both groups), showed similar results. In cardiogenic shock, ECLS showed a 33 % higher 30-day survival compared with IABP (95 % CI, 14–52 %; p < 0.001; NNT 13) but no difference when compared with TandemHeart/Impella (−3 %; 95 % CI −21 to 14 %; p = 0.70; NNH 33).ConclusionsIn cardiac arrest, the use of ECLS was associated with an increased survival rate as well as an increase in favourable neurological outcome. In the setting of cardiogenic shock there was an increased survival with ECLS compared with IABP.Electronic supplementary materialThe online version of this article (doi:10.1007/s00134-016-4536-8) contains supplementary material, which is available to authorized users.

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Delayed awakening after cardiac arrest: prevalence and risk factors in the Parisian registry

Cited by 119 publications

References 40 publications

In-Hospital Cardiac Arrest

In-Hospital Cardiac Arrest

Quantitative versus standard pupillary light reflex for early prognostication in comatose cardiac arrest patients: an international prospective multicenter double-blinded study

Extracorporeal life support during cardiac arrest and cardiogenic shock: a systematic review and meta-analysis

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