AHA: Wait, possibly, before stopping hypothermia for arrest patients

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CHICAGO—Cardiac arrest patients treated with hypothermia may achieve neurological awakening that’s not apparent for several days to a week after physicians routinely make recommendations about whether to withdraw care, according to research presented Nov. 13 at the American Heart Association (AHA) Scientific Sessions.

For more than 25 years, the prognosis for recovery from cardiac arrest and the decision to withdraw care has been based on a neurological exam at 72 hours, explained Shaker M. Eid, MD, assistant professor of medicine at Johns Hopkins University School of Medicine in Baltimore. Therefore, the study’s finding could have “profound implications on when withdrawal-of-care decisions will be made for these patients,” he said.

The researchers evaluated 47 patients who survived non-traumatic out-of-hospital cardiac arrest and were admitted to an academic medical center.

Eid reported 15 patients received therapeutic hypothermia (cooling the body to 33 degrees Celsius), and 46.6 percent survived to discharge. Of the 32 patients who did not receive hypothermia, 40.6 percent survived to discharge.

The researchers assessed the brain activity level daily in all patients, and they found:

  • Within three days, 38.5 percent of patients receiving conventional care (no hypothermia) were alert after resuscitation and considered to have mild deficits.
  • At day three, no hypothermia patients were alert and conscious.
  • At day seven, 33 percent of hypothermia patients had regained alertness and were considered to have mild deficits.
  • At discharge, 83 percent of hypothermia patients were alert and considered to have only mild deficits.

“These data suggest that the contrary to the established paradigm, that patients with hypothermia achieve substantial neurological awakening that may start at day three but is not apparent until day seven—and possibly longer,” Eid and his colleagues concluded.

However, he added that their findings should be validated in a study with a higher number of patients.

The findings were presented during the fourth annual Resuscitation Science Symposium, which runs concurrent to the AHA conference.