Dataset Information

The association of brainstem and motor recovery with awakening after out-of-hospital cardiac arrest.

ABSTRACT:

Background

Coma is common following resuscitation from cardiac arrest. Few data describe the trajectory of recovery the first days following resuscitation. The objective of this study is to describe the evolution in neurological examination during the first 5 days after resuscitation and test if subjects who go on to awaken have different patterns of early recovery.

Methods

Prospective study of adult subjects resuscitated from out-of-hospital cardiac arrest. We abstracted demographic information and trained clinicians completed daily neurologic examinations using the Glasgow Coma Scale (GCS) and Full Outline of UnResponsiveness brainstem (FOUR-B) and motor (FOUR-M) scores during daily sedation interruption. The change in scores between Day 1 and Day 5 was analyzed using the Kruskal-Wallis Test and logistic regression models. The relationship of FOUR-B, FOUR-M, and GCS with time to death was estimated by fitting cox proportional hazard models.

Results

FOUR-M and GCS did not differ over time (p = 0.10; p = 0.07). FOUR B increased over time (p < 0.01). Time to recovery of brainstem or motor function differed between those treated at 33 °C and 36 °C (p = 0.0023 and p = 0.0032, respectively). FOUR-B, FOUR-M, and GCS differed between survivors and non-survivors (p < 0.01). Time to recovery of brainstem and motor function differed between survivors and non-survivors. FOUR-M and FOUR-B differed between those with good outcome and poor outcome.

Conclusions

The brainstem clinical examination improved during the first 5 days following resuscitation. Brainstem recovery was common in entire cohort and did not differentiate between survivors and non-survivors. Recovery of motor function, however, was associated with survival.

SUBMITTER: I Cardi A

PROVIDER: S-EPMC9758564 | biostudies-literature | 2022 Dec

REPOSITORIES: biostudies-literature

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Publications

The association of brainstem and motor recovery with awakening after out-of-hospital cardiac arrest.

I Cardi Alessandra A Drohan Callie M CM Elmer Jonathan J Callaway Clifton W CW X Guyette Francis F Doshi Ankur A AA Rittenberger Jon C JC

Resuscitation plus 20221208

<h4>Background</h4>Coma is common following resuscitation from cardiac arrest. Few data describe the trajectory of recovery the first days following resuscitation. The objective of this study is to describe the evolution in neurological examination during the first 5 days after resuscitation and test if subjects who go on to awaken have different patterns of early recovery.<h4>Methods</h4>Prospective study of adult subjects resuscitated from out-of-hospital cardiac arrest. We abstracted demograp ...[more]

PMID: 36536825

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Project description:Background For individuals with an out-of-hospital cardiac arrest (OHCA), survival may be influenced by the neighborhood in which the arrest occurs. Methods and Results Within the national CARES (Cardiac Arrest Registry to Enhance Survival) registry, we identified 169 502 patients with OHCA from 2013 to 2017. On the basis of census tract data, OHCAs were categorized as occurring in predominantly white (>80% white), majority black (>50% black), or integrated (neither of these 2) neighborhoods and in low-income (median household <$40 000), middle-income ($40 000 to $80 000), or high-income (>$80 000) neighborhoods. With hierarchical logistic regression, the association of neighborhood race and income on overall survival was assessed. Overall, 37.5%, 16.6%, and 45.9% of people had an OHCA in predominantly white, majority black, and integrated neighborhoods, and 30.1%, 53.4%, and 16.5% in low-, middle-, and high-income neighborhoods, respectively. Compared with OHCAs occurring in predominantly white neighborhoods, those in majority black neighborhoods were 12% less likely (6.9% versus 10.6%; adjusted odds ratio 0.88; 95% CI 0.82-0.95; P<0.001) to survive to discharge, whereas those in integrated neighborhoods had similar survival (10.3% versus 10.6%; adjusted odds ratio 1.00; 95% CI 0.96-1.04; P=0.93). Compared with high-income neighborhoods, those in middle-income neighborhoods were 11% (10.1% versus 11.3%; adjusted odds ratio 0.89; 95% CI 0.8-0.94; P<0.001) less likely to survive to discharge, whereas those in low-income neighborhoods were 12% (8.6% versus 11.3%; adjusted odds ratio 95% CI 0.83-0.94; P<0.001) less likely to survive. Differential rates of bystander cardiopulmonary resuscitation only modestly attenuated neighborhood differences in survival. Conclusions OHCAs in majority black and non-high-income neighborhoods have lower survival rates, and these differences were not explained by differential bystander cardiopulmonary resuscitation rates.

Dataset Information

The association of brainstem and motor recovery with awakening after out-of-hospital cardiac arrest.

Background

Methods

Results

Conclusions

Publications

The association of brainstem and motor recovery with awakening after out-of-hospital cardiac arrest.

Similar Datasets

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