Predictors of Neurological Outcomes in Out-of-Hospital Cardiac Arrest Survivors Treated with Therapeutic Hypothermia

ABSTRACT

PURPOSE: Many studies have shown that therapeutic hypothermia (TH) administration to non-ventricular fibrillation (Vf) cardiac arrest survivors or non-cardiac origin arrest survivors leads to good neurological outcomes. Therefore, TH has been regarded as a standard therapy for cardiac arrest survivors. Our study was designated to analyze predictors of neurological outcomes in out-of-hospital cardiac arrest (OHCA) survivors throughout the duration of the event, from the detection of arrest to the end of TH. METHODS: We retrospectively reviewed the cases of sixty OHCA survivors treated with TH between January 2006 and December 2008. We divided the patients into two groups according to the Cerebral Performance Categories scale at discharge and statistically compared the factors associated with neurological outcomes. RESULTS: Younger age, absence of diabetes mellitus, Vf of initial rhythm, and cardiac origin of cardiac arrest were associated with good neurological outcomes. The frequency of witnessed arrest was higher in the good outcomes group. The time intervals from detection of arrest to emergency department arrival (EDA) and performance of advanced cardiac life support were shorter in the good outcomes group. Mean blood pressure at implementation of TH and the frequency of hypomagnesemia were higher in the poor outcomes group. Logistic regression revealed that an independent predictor of good outcomes was the time interval from the detection of arrest to EDA (95% CI, 0.792-0.988). CONCLUSION: An independent predictor of good neurological outcomes is the time interval from detection of arrest to EDA. Improvable components of TH were early implementation of TH, avoiding hypomagnesemia, and slow rewarming.