Time to awakening after cardiac arrest and the association with target temperature management

TY - JOUR

T1 - Time to awakening after cardiac arrest and the association with target temperature management

AU - Lybeck, Anna

AU - Cronberg, Tobias

AU - Aneman, Anders

AU - Hassager, Christian

AU - Horn, Janneke

AU - Hovdenes, Jan

AU - Kjærgaard, Jesper

AU - Kuiper, Michael

AU - Wanscher, Michael

AU - Stammet, Pascal

AU - Wise, Matthew P

AU - Nielsen, Niklas

AU - Ullén, Susann

AU - Friberg, Hans

AU - TTM-Trial Investigators

N1 - Copyright © 2018 Elsevier B.V. All rights reserved.

PY - 2018/5

Y1 - 2018/5

N2 - Aim: Target temperature management (TTM) at 32–36 °C is recommended in unconscious survivors of cardiac arrest. This study reports awakening in the TTM-trial. Our predefined hypotheses were that time until awakening correlates with long-term neurological outcome and is not affected by level of TTM. Methods: Post-hoc analysis of time until awakening after cardiac arrest, its association with long-term (180-days) neurological outcome and predictors of late awakening (day 5 or later). The trial randomized 939 comatose survivors to TTM at 33 °C or 36 °C with strict criteria for withdrawal of life-sustaining therapies. Administered sedation in the treatment groups was compared. Awakening was defined as a Glasgow Coma Scale motor score 6. Results: 496 patients had registered day of awakening in the ICU, another 43 awoke after ICU discharge. Good neurological outcome was more common in early (275/308, 89%) vs late awakening (142/188, 76%), p < 0.001. Awakening occurred later in TTM33 than in TTM36 (p = 0.002) with no difference in neurological outcome, or cumulative doses of sedative drugs at 12, 24 or 48 h. TTM33 (p = 0.006), clinical seizures (p = 0.004), and lower GCS-M on admission (p = 0.03) were independent predictors of late awakening. Conclusion: Late awakening is common and often has a good neurological outcome. Time to awakening was longer in TTM33 than in TTM36, this difference could not be attributed to differences in sedative drugs administered during the first 48 h.

AB - Aim: Target temperature management (TTM) at 32–36 °C is recommended in unconscious survivors of cardiac arrest. This study reports awakening in the TTM-trial. Our predefined hypotheses were that time until awakening correlates with long-term neurological outcome and is not affected by level of TTM. Methods: Post-hoc analysis of time until awakening after cardiac arrest, its association with long-term (180-days) neurological outcome and predictors of late awakening (day 5 or later). The trial randomized 939 comatose survivors to TTM at 33 °C or 36 °C with strict criteria for withdrawal of life-sustaining therapies. Administered sedation in the treatment groups was compared. Awakening was defined as a Glasgow Coma Scale motor score 6. Results: 496 patients had registered day of awakening in the ICU, another 43 awoke after ICU discharge. Good neurological outcome was more common in early (275/308, 89%) vs late awakening (142/188, 76%), p < 0.001. Awakening occurred later in TTM33 than in TTM36 (p = 0.002) with no difference in neurological outcome, or cumulative doses of sedative drugs at 12, 24 or 48 h. TTM33 (p = 0.006), clinical seizures (p = 0.004), and lower GCS-M on admission (p = 0.03) were independent predictors of late awakening. Conclusion: Late awakening is common and often has a good neurological outcome. Time to awakening was longer in TTM33 than in TTM36, this difference could not be attributed to differences in sedative drugs administered during the first 48 h.

KW - Aged

KW - Body Temperature

KW - Coma/drug therapy

KW - Female

KW - Humans

KW - Hypnotics and Sedatives/administration & dosage

KW - Hypothermia, Induced/methods

KW - Male

KW - Middle Aged

KW - Out-of-Hospital Cardiac Arrest/therapy

KW - Single-Blind Method

KW - Time Factors

KW - Wakefulness/drug effects

KW - Withholding Treatment

U2 - 10.1016/j.resuscitation.2018.01.027

DO - 10.1016/j.resuscitation.2018.01.027

M3 - Journal article

C2 - 29371115

SN - 0300-9572

VL - 126

SP - 166

EP - 171

JO - Resuscitation

JF - Resuscitation

ER -