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Documentation of neurological status in patients admitted to an intensive care unit after cardiac arrest: A 10-year cohort study

Published:October 26, 2021DOI:https://doi.org/10.1016/j.aucc.2021.08.008

      Abstract

      Objective

      The objective of this study was to describe the documented neurological assessment and investigations for neuroprognostication in patients after cardiac arrest.

      Design, setting, and participants

      This was a retrospective cohort study of adult patients after cardiac arrest, admitted to a tertiary intensive care unit (ICU), between January 2009 and December 2018.

      Main outcome measures

      The main outcome measures were the proportion of patients with a documented Glasgow Coma Scale (GCS) score and investigations for neuroprognostication.

      Results

      Four hundred twenty-seven patients formed the study cohort. The GCS score was documented for 267 (63%) patients at some time during their ICU stay. The proportion of patients with the GCS score documented decreased each day of ICU stay (59% at day 1, 20% at day 5). Pupil reflex to light was recorded in 352 (82%), corneal reflex in 155 (36%), and limb reflexes in 216 (51%) patients. Twenty-eight (6.6%) patients underwent brain magnetic resonance imaging, 10 (2.3%) an electroencephalogram, and two somatosensory evoked potentials. Withdrawal of life-sustaining treatments occurred in 166 (39%) patients, and 221 (52%) patients died in hospital.

      Conclusions

      In this single-centre study of patients admitted to the ICU after cardiac arrest, the GCS score was inconsistently documented, and investigations for neuroprognostication were infrequent.

      Keywords

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      References

        • Oddo M.
        • Friberg H.
        Neuroprognostication after cardiac arrest in the light of targeted temperature management.
        Curr Opin Crit Care. 2017; 23: 244-250
        • Bateman D.E.
        Neurological assessment of coma.
        J Neurol Neurosurg Psychiatry. 2001; 71: i13-i17
        • Perman S.M.
        • Kirkpatrick J.N.
        • Reitsma A.M.
        • Gaieski D.F.
        • Lau B.
        • Smith T.M.
        • et al.
        Timing of neuroprognostication in postcardiac arrest therapeutic hypothermia.
        Crit Care Med. 2012; 40: 719-724
        • Ebell M.H.
        • Jang W.
        • Shen Y.
        • Geocadin R.G.
        Get with the Guidelines-Resuscitation Investigators. Development and validation of the Good Outcome Following Attempted Resuscitation (GO-FAR) score to predict neurologically intact survival after in-hospital cardiopulmonary resuscitation.
        JAMA Intern Med. 2013; 173: 1872-1878
        • Sandroni C.
        • D'Arrigo S.
        • Nolan J.P.
        Prognostication after cardiac arrest.
        Crit Care. 2018; 22 (150-018)
        • Rossetti A.O.
        • Rabinstein A.A.
        • Oddo M.
        Neurological prognostication of outcome in patients in coma after cardiac arrest.
        Lancet Neurol. 2016; 15: 597-609
        • Callaway C.W.
        • Donnino M.W.
        • Fink E.L.
        • Geocadin R.G.
        • Golan E.
        • Kern K.B.
        • et al.
        Part 8: post-cardiac arrest care: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care.
        Circulation. 2015; 132: S465-S482
        • Nolan J.P.
        • Soar J.
        • Cariou A.
        • Cronberg T.
        • Moulaert V.R.
        • Deakin C.D.
        • et al.
        European resuscitation Council and European Society of intensive care medicine 2015 guidelines for post-resuscitation care.
        Intensive Care Med. 2015; 41: 2039-2056
        • Australia and New Zealand Intensive Care Society
        The ANZICS statement on death and organ donation.
        Edition 4. 2019 ([Camberwell (Australia)])
        • Sandroni C.
        • Cavallaro F.
        • Callaway C.W.
        • D’Arrigo S.
        • Sanna T.
        • Kuiper M.A.
        • et al.
        Predictors of poor neurological outcome in adult comatose survivors of cardiac arrest: a systematic review and meta-analysis. Part 2: patients treated with therapeutic hypothermia.
        Resuscitation. 2013; 84: 1324-1338
        • Sandroni C.
        • Cavallaro F.
        • Callaway C.W.
        • Sanna T.
        • D’Arrigo S.
        • Kuiper M.
        • et al.
        Predictors of poor neurological outcome in adult comatose survivors of cardiac arrest: a systematic review and meta-analysis. Part 1: patients not treated with therapeutic hypothermia.
        Resuscitation. 2013; 84: 1310-1323
        • Zhou S.E.
        • Maciel C.B.
        • Ormseth C.H.
        • Beekman R.
        • Gilmore E.J.
        • Greer D.M.
        Distinct predictive values of current neuroprognostic guidelines in post-cardiac arrest patients.
        Resuscitation. 2019; 139: 343-350
        • Maciel C.B.
        • Barden M.M.
        • Youn T.S.
        • Dhakar M.B.
        • Greer D.M.
        Neuroprognostication practices in postcardiac arrest patients: an international survey of critical care providers.
        Crit Care Med. 2020; 48: e107-e114
        • Mandigers L.
        • Termorshuizen F.
        • de Keizer N.F.
        • Gommers D.
        • dos Reis Miranda D.
        • Rietdijk W.J.
        • et al.
        A nationwide overview of 1-year mortality in cardiac arrest patients admitted to intensive care units in The Netherlands between 2010 and 2016.
        Resuscitation. 2020; 147: 88-94
        • Mulder M.
        • Gibbs H.G.
        • Smith S.W.
        • Dhaliwal R.
        • Scott N.L.
        • Sprenkle M.D.
        • et al.
        Awakening and withdrawal of life-sustaining treatment in cardiac arrest survivors treated with therapeutic hypothermia.
        Crit Care Med. 2014; 42: 2493-2499
        • Young P.
        • Mackle D.
        • Bellomo R.
        • Bailey M.
        • Beasley R.
        • Deane A.
        • et al.
        Conservative oxygen therapy for mechanically ventilated adults with suspected hypoxic ischaemic encephalopathy.
        Intensive Care Med. 2020; 46: 2411-2422
        • Soto C.L.
        • Dragoi L.
        • Heyn C.C.
        • Kramer A.
        • Pinto R.
        • Adhikari N.K.
        • et al.
        Imaging for neuroprognostication after cardiac arrest: systematic review and meta-analysis.
        Neurocritical Care. 2020; 32: 206-216
        • Peberdy M.A.
        • Callaway C.W.
        • Neumar R.W.
        • Geocadin R.G.
        • Zimmerman J.L.
        • Donnino M.
        • et al.
        Part 9: post-cardiac arrest care: 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care.
        Circulation. 2010; 122: S768-S786
        • Rossetti A.O.
        • Urbano L.A.
        • Delodder F.
        • Kaplan P.W.
        • Oddo M.
        Prognostic value of continuous EEG monitoring during therapeutic hypothermia after cardiac arrest.
        Crit Care. 2010; 14: 1-8
        • Sivaraju A.
        • Gilmore E.J.
        • Wira C.R.
        • Stevens A.
        • Rampal N.
        • Moeller J.J.
        • et al.
        Prognostication of post-cardiac arrest coma: early clinical and electroencephalographic predictors of outcome.
        Intensive Care Med. 2015; 41: 1264-1272
        • Amorim E.
        • Ghassemi M.M.
        • Lee J.W.
        • Greer D.M.
        • Kaplan P.W.
        • Cole A.J.
        • et al.
        Estimating the false positive rate of absent somatosensory evoked potentials in cardiac arrest prognostication.
        Crit Care Med. 2018; 46: e1213-e1221
        • Geocadin R.G.
        • Callaway C.W.
        • Fink E.L.
        • Golan E.
        • Greer D.M.
        • Ko N.U.
        • et al.
        Standards for studies of neurological prognostication in comatose survivors of cardiac arrest: a scientific statement from the American Heart Association.
        Circulation. 2019; 140: e517-e542
        • Sandroni C.
        • Grippo A.
        • Nolan J.P.
        ERC-ESICM guidelines for prognostication after cardiac arrest: time for an update.
        Intensive Care Med. 2020;
      1. Eastwood G, Bellomo R, Nichol A, et al. Targeted therapeutic mild hypercapnia after resuscitated cardiac arrest: a phase III multi-centre randomised controlled trial. Trial protocol version 1, dated 20th June 2017.

      2. Nielsen, N. Targeted hypothermia versus targeted normothermia after out-of-hospital cardiac arrest. A randomised clinical trial. Trial protocol version 1, dated 17th May 2017.

        • Teasdale G.
        • Jennett B.
        Assessment of coma and impaired consciousness. A practical scale.
        Lancet. 1974; 2: 81-84