Late awakening, prognostic factors and long-term outcome in out-of-hospital cardiac arrest - results of the prospective Norwegian Cardio-Respiratory Arrest Study (NORCAST)

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Article

Nakstad, Espen R.¹  Staer-Jensen, Henrik²  Wimmer, Henning¹  Henriksen, Julia³  Alteheld, Lars H.³  Reichenbach, Antje⁴  Draegni, Tomas⁵  Altyte-Benth, Jurate^6,7  Wilson, John Aage⁸  Etholm, Lars⁹  Oijordsbakken, Miriam¹⁰  Eritsland, Jan¹¹  Seljeflot, Ingebjorg^11,12  Jacobsen, Dag^1,12  Andersen, Geir O.¹¹  Lundqvist, Christofer^4,7,12  Sunde, Kjetil^2,12 

[1] Oslo Univ Hosp, Dept Acute Med, Postboks 4956 Nydalen, N-0424 Oslo, Norway

[2] Oslo Univ Hosp, Dept Anaesthesiol, Postboks 4956 Nydalen, N-0424 Oslo, Norway

[3] Oslo Univ Hosp, Dept Neurol, Postboks 4956 Nydalen, N-0424 Oslo, Norway

[4] Akershus Univ Hosp, Dept Neurol, Postboks 1000, N-1478 Lorenskog, Norway

[5] Oslo Univ Hosp, Dept Res & Dev, Postboks 4956 Nydalen, N-0424 Oslo, Norway

[6] Univ Oslo, Campus Akershus Univ Hosp, Inst Clin Med, PB 1171 Blindern, N-0318 Oslo, Norway

[7] Akershus Univ Hosp, Hlth Serv Res Unit, Postboks 1000, N-1478 Lorenskog, Norway

[8] Oslo Univ Hosp, Natl Ctr Epilepsy, Postboks 4950 Nydalen, N-0424 Oslo, Norway

[9] Oslo Univ Hosp, Dept Neurophysiol, Postboks 4950 Nydalen, N-0424 Oslo, Norway

[10] Oslo Univ Hosp, Norwegian Radium Hosp, Dept Biochem, Postboks 4953 Nydalen, N-0424 Oslo, Norway

[11] Oslo Univ Hosp, Dept Cardiol, Postboks 4956 Nydalen, N-0424 Oslo, Norway

[12] Univ Oslo, Inst Clin Med, PB 1171 Blindern, N-0318 Oslo, Norway

关键词: Out-of-hospital cardiac arrest;    Prognostication;    Sedation;    Targeted temperature management;    Withdrawal of life-sustaining therapy;    Cerebral performance category;    Glasgow coma scale;    Neuron-specific enolase;    EEG;    SSEP;   

DOI  :  10.1016/j.resuscitation.2019.12.031

来源: Elsevier

【 摘 要 】

Background: Outcome prediction after out-of-hospital cardiac arrest (OHCA) may lead to withdrawal of life-sustaining therapy if the prognosis is perceived negative. Single use of uncertain prognostic tools may lead to self-fulfilling prophecies and death. We evaluated prognostic tests, blinded to clinicians and without calls for hasty outcome prediction, in a prospective study. Methods: Comatose, sedated TTM 33-treated OHCA patients of all causes were included. Clinical-neurological/-neurophysiological/-biochemical predictors were registered. Patients were dichotomized into good/poor outcome using cerebral performance category (CPC) six months and > four years post-arrest. Prognostic tools were evaluated using false positive rates (FPR). Results: We included 259 patients; 49 % and 42 % had good outcome (CPC 1-2) after median six months and 5.1 years. Unwitnessed arrest, non-shockable rhythms, and no-bystander-CPR predicted poor outcome with FPR (CI) 0.05 (0.02-0.10), 0.13 (0.08-0.21), and 0.13 (0.07-0.20), respectively. Time to awakening was median 6 (0-25) days in good outcome patients. Among patients alive with sedation withdrawal >72 h, 49 % were unconscious, of whom 32 % still obtained good outcome. Only absence of pupillary light reflexes (PLR) -and N20-responses in somato-sensory evoked potentials (SSEP), as well as increased neuron-specific enolase (NSE) later than 24 h to >80 mu g/L, had FPR 0. Malignant EEG (burst suppression/epileptic activity/flat) differentiated poor/good outcome with FPR 0.05 (0.01-0.15). Conclusion: Time to awakening was over six days in good outcome patients. Most clinical parameters had too high FPRs for prognostication, except for absent PLR and SSEP-responses >72 h after sedation withdrawal, and increased NSE later than 24 h to >80 mu g/L.

【 授权许可】

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