Time to awakening after cardiac arrest and the association with target temperature management.
Resuscitation
; 126: 166-171, 2018 05.
Article
em En
| MEDLINE
| ID: mdl-29371115
ABSTRACT
AIM:
Target temperature management (TTM) at 32-36⯰C is recommended in unconscious survivors of cardiac arrest. This study reports awakening in the TTM-trial. Our predefined hypotheses were that time until awakening correlates with long-term neurological outcome and is not affected by level of TTM.METHODS:
Post-hoc analysis of time until awakening after cardiac arrest, its association with long-term (180-days) neurological outcome and predictors of late awakening (day 5 or later). The trial randomized 939 comatose survivors to TTM at 33⯰C or 36⯰C with strict criteria for withdrawal of life-sustaining therapies. Administered sedation in the treatment groups was compared. Awakening was defined as a Glasgow Coma Scale motor score 6.RESULTS:
496 patients had registered day of awakening in the ICU, another 43 awoke after ICU discharge. Good neurological outcome was more common in early (275/308, 89%) vs late awakening (142/188, 76%), pâ¯<â¯0.001. Awakening occurred later in TTM33 than in TTM36 (pâ¯=â¯0.002) with no difference in neurological outcome, or cumulative doses of sedative drugs at 12, 24 or 48â¯h. TTM33 (pâ¯=â¯0.006), clinical seizures (pâ¯=â¯0.004), and lower GCS-M on admission (pâ¯=â¯0.03) were independent predictors of late awakening.CONCLUSION:
Late awakening is common and often has a good neurological outcome. Time to awakening was longer in TTM33 than in TTM36, this difference could not be attributed to differences in sedative drugs administered during the first 48â¯h.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Vigília
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Coma
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Parada Cardíaca Extra-Hospitalar
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Hipnóticos e Sedativos
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Hipotermia Induzida
Tipo de estudo:
Clinical_trials
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Prognostic_studies
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Risk_factors_studies
Limite:
Aged
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
Resuscitation
Ano de publicação:
2018
Tipo de documento:
Article