Faculty Collaboration Database

Cardiac arrest, mild therapeutic hypothermia, and unanticipated cerebral recovery. Neurologist 2007 Nov;13(6):369-75

Date

12/20/2007

Pubmed ID

18090715

DOI

10.1097/NRL.0b013e3180de4dc3

Scopus ID

2-s2.0-37349003764 (requires institutional sign-in at Scopus site)   20 Citations

Abstract

OBJECTIVES: Animal and human studies support mild therapeutic hypothermia as an effective means of preventing brain injury in comatose patients resuscitated from cardiac arrest. However, there is little clinical experience with predicting neurologic outcome in this patient population. We present 4 comatose patients resuscitated from cardiac arrest treated with mild hypothermia whose in-hospital neurologic prognosis was determined by board-certified neurologists to be grave, yet were ultimately discharged from the hospital with no or minimal neurologic sequelae.

RESULTS: We report 4 comatose patients resuscitated from cardiac arrest treated with mild hypothermia. On hospital admission, all patients had a Glasgow Coma Score between 3 and 6 and a FOUR Score between 1 and 5. Mild hypothermia (32 degrees C - 33 degrees C) was implemented for 24 to 40 hours. Examination by board-certified neurologists before and during hypothermia or the rewarming phase suggested a grave prognosis. All 4 patients had sudden and dramatic neurologic recovery 9 to 24 hours after rewarming to normothermia and were ultimately discharged with no or minimal neurocognitive sequelae.

CONCLUSION: This case series suggests that neurologic assessment-based prognosis of patients after cardiac arrest undergoing therapeutic mild hypothermia should be considered unreliable for at least the first 72 hours. Use of additional assessments such as brain injury markers or evoked potentials, in addition to clinical examination, should be strongly considered to help determine an estimated prognosis. Functional reversibility after a global insult could be an intrinsic potential of the brain, similar to myocardial stunning, and deserves investigation.

Author List

Yannopoulos D, Kotsifas K, Aufderheide TP, Lurie KG

Author

Tom P. Aufderheide MD Professor in the Emergency Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Body Temperature
Brain
Brain Infarction
Death, Sudden, Cardiac
Decerebrate State
Diagnostic Errors
Emergency Medical Services
Female
Glasgow Coma Scale
Humans
Hypothermia, Induced
Hypoxia-Ischemia, Brain
Male
Middle Aged
Myocardial Stunning
Predictive Value of Tests
Prognosis
Recovery of Function
Reperfusion Injury
Time Factors
Treatment Outcome