Improvement of consciousness before initiating targeted temperature management

Abstract

Introduction: Following cardiac arrest, return of spontaneous circulation (ROSC) in patients may be followed by spontaneous neurological recovery, which may decrease the potential adverse effects of treatments in post-cardiac arrest care, including those of Targeted Temperature Management (TTM). We investigated the percentage of post-arrest patients who experienced spontaneous neurological recovery, and the characteristics and neurological outcomes of these patients.

Methods: A total of 540 patients with ROSC were retrospectively enrolled in this single-center observational study. The patients' motor responses were documented immediately and at 3 h following ROSC. Predictors of spontaneous neurological recovery were assessed by multiple logistic regression analysis.

Results: A total of 221 patients (41%) showed a change in their GCS (Glasgow Coma Score) M score (motor score) during the 3-h interval following ROSC, with improvement evident in 215 patients. Among 96 patients with GCS M6 at 3 h, 83 (86%) were discharged with a favorable neurological outcome. GCS M6 at 3 h post ROSC, was an independent predictor for a favorable neurological outcome, but GCS M6 at ROSC was not. There were four factors predicting the GCS M6 at 3 h; including in-hospital cardiac arrest (OR 3.057; 95% CI: 1.370-6.824, P = 0.006); bystander CPR (OR 13.311; 95% CI: 6.455-27.447, P < 0.0001); the CPR duration (OR, 0.941; 95% CI: 0.91-0.974; P < 0.0001), and the initial shockable rhythm (OR, 4.41; 95% CI: 2.44-7.95; P < 0.0001).

Conclusions: A significant portion of patients had spontaneous neurological recovery to GCS M6 within 3 h post ROSC, and had a favorable neurological outcome. Close monitoring of GCS and later initiation of TTM should be considered in those patients with a substantial likelihood of neurological recovery.

Keywords: Neurological outcome; Post-cardiac arrest care; Targeted temperature management.