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Predictors of poor neurologic outcome after induced mild hypothermia following cardiac arrest

From the Departments of Clinical Neurological Sciences (E.A.T., M.S., B.Y.) and Anesthesia and Perioperative Medicine (M.S., L.N.), Program in Critical Care, University of Western Ontario, London, Canada; Department of Medicine (E.A.T.), King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia; and Department of Neurosciences (M.S.), Hôpital de l’Enfant-Jésus du CHA, Laval University, Quebec City, Quebec, Canada.

Address correspondence and reprint requests to Dr. G. Bryan Young, Department of Clinical Neurological Sciences, London Health Sciences Centre-University Hospital, 339 Windermere Rd., London, Ontario, Canada N6A5A5

Background: Several predictors of poor neurologic outcome after cardiac arrest (CA) were proven to be valid. However, these studies preceded the advent of therapeutic induced mild hypothermia (TIMH), which may alter their validity. The objective of this study is to reassess the validity of these predictors in post-CA patients treated with TIMH.

Methods: Retrospective chart review of 37 consecutive adults who were comatose after resuscitation from CA and treated with TIMH.

Results: None of six patients without pupillary reactivity, six without corneal reflexes on day 3, or eight with myoclonus status epilepticus recovered awareness. Two of 14 patients with motor responses no better than extension at day 3 recovered motor responses only after 6 days post-arrest (one at 5 and one at 6 days post-rewarming) and regained awareness.

Conclusions: Loss of motor responses better than extension on day 3 was not prognostically reliable after therapeutic induced mild hypothermia for comatose cardiac arrest survivors. None of the patients who lost pupillary or corneal reflexes on day 3 or developed myoclonus status epilepticus recovered awareness.

Abbreviations: AAN = American Academy of Neurology; CA = cardiac arrest; FPR = false-positive rate; SSEP = somatosensory evoked potential; TIMH = therapeutic induced mild hypothermia.

Disclosure: The authors report no disclosures.

Received November 13, 2007. Accepted in final form August 5, 2008.

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