Determinants of Long-Term Neurological Recovery Patterns Relative to Hospital Discharge Among Cardiac Arrest Survivors. Issue 2 (February 2018)

• Record Type: Journal Article
• Authors: Agarwal, Sachin; Presciutti, Alex; Roth, William; Matthews, Elizabeth; Rodriguez, Ashley; Roh, David J.; Park, Soojin; Claassen, Jan; Lazar, Ronald M.
• Is Part Of: Critical care medicine. Volume 46:Issue 2(2018)
• Publication Date: 2018-02
• Subjects: cardiac arrest -- Cerebral Performance Category score -- clinical outcomes -- neurological recovery -- targeted temperature management; Critical care medicine -- Periodicals; Soins intensifs -- Périodiques; 616.028
• DOI: 10.1097/CCM.0000000000002846
• Languages: English
• ISSNs: 0090-3493

Abstract

Abstract : Objective: To explore factors associated with neurological recovery at 1 year relative to hospital discharge after cardiac arrest. Design: Observational, retrospective review of a prospectively collected cohort. Setting: Medical or surgical ICUs in a single tertiary care center. Patients: Older than 18 years, resuscitated following either in-hospital or out-of-hospital cardiac arrest and considered for targeted temperature management between 2007 and 2013. Interventions: None. Measurements and Main Results: Logistic regressions to determine factors associated with a poor recovery pattern after 1 year, defined as persistent Cerebral Performance Category Score 3–4 or any worsening of Cerebral Performance Category Score relative to discharge status. In total, 30% (117/385) of patients survived to hospital discharge; among those discharged with Cerebral Performance Category Score 1, 2, 3, and 4, good recovery pattern was seen in 54.5%, 48.4%, 39.5%, and 0%, respectively. Significant variables showing trends in associations with a poor recovery pattern (62.5%) in a multivariate model were age more than 70 years (odds ratio, 4; 95% CIs, 1.1–15; p = 0.04), Hispanic ethnicity (odds ratio, 4; CI, 1.2–13; p = 0.02), and discharge disposition (home needing out-patient services (odds ratio, 1), home requiring no additional services (odds ratio, 0.15; CI, 0.03–0.8; p = 0.02), acute rehabilitation (odds ratio, 0.23; CI, 0.06–0.9; p = 0.04). Conclusions: Patients discharged with mild or moderate cerebral dysfunction sustained their risk of neurological worsening within 1 year of cardiac arrest. Old age, Hispanic ethnicity, and discharge disposition of home with out-patient services may be associated with a poor 1 year neurological recovery pattern after hospital discharge from cardiac arrest. Abstract : Supplemental Digital Content is available in the text.