Don’t pull the plug too soon after cardiac arrest

Survival statistics are grim for those who suffer cardiac arrest outside the hospital.

Although about 50 percent of people who arrest are revived after attempted resuscitation, only about 10 percent of these survive to leave the hospital. And almost half of the survivors suffer some level of brain impairment from hypoxia (when the brain is not getting enough oxygen).

“We may be able to save thousands of lives each year across the country by simply giving cardiac arrest victims more time to awaken.”

But there’s new evidence that physicians may be drawing conclusions too soon about survival outcomes. They may need to allow comatose cardiac arrest patients much more time to awaken before making a prognosis.

“Most patients are comatose after resuscitation and accurately predicting those who will wake up can be extremely challenging,” says Bentley Bobrow, professor at the University of Arizona Colleges of Medicine in Tucson and Phoenix.

“There are many factors involved, but we know that it is common for doctors to try to decide who will and who won’t wake up after 24 to 48 hours of hospitalization. However, our study found that a substantial number of cardiac arrest victims wake up longer than many people would expect.

“Sometimes they awaken from coma five, six, or seven days after being admitted to the hospital and many of these have a good neurological outcome.”

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Among 573 out-of-hospital cardiac arrest patients who completed targeted temperature management (cooling the body to protect the brain), 60 woke up at least 48 hours after rewarming. Eight patients became responsive more than seven days after rewarming, six of whom were discharged with good neurological scores.

One of the important findings was no predictive factors reliably identified who would awaken early or late. The study was recently published in the Annals of Emergency Medicine.

“We were surprised by the large proportion of cardiac arrest survivors who woke up more than three days after their arrest and went home with their families,” Bobrow says.

“While targeted therapeutic hypothermia has been shown to improve outcomes, no validated system currently exists for predicting when patients receiving this treatment will awaken from coma,” he says. “Physicians and family members may need to wait longer than the traditional three days before making irrevocable decisions about brain function recovery and possible withdrawal of care.”

Daniel Spaite, University of Arizona professor, says the study “quantifies the timing of awakening from a coma after cardiac arrest in the era of targeted temperature management, and this timing is much different than before we had this treatment.”

As a result, “we may be able to save thousands of lives each year across the country by simply giving cardiac arrest victims more time to awaken in the hospital,” says Samuel Keim, professor and chair of the emergency medicine department.

Source: University of Arizona

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Source: Futurity