Department of Emergency Medicine, Center for Resuscitation Science, University of Pennsylvania, United States.
Resuscitation. 2013 Dec;84(12):1741-6. doi: 10.1016/j.resuscitation.2013.07.009. Epub 2013 Aug 1.
Therapeutic hypothermia (TH) has been shown to improve outcomes in comatose Post-Cardiac Arrest Syndrome (PCAS) patients. It is unclear how long it takes these patients to regain neurologic responsiveness post-arrest. We sought to determine the duration to post-arrest awakening and factors associated with times to such responsiveness.
We performed a retrospective chart review of consecutive TH-treated PCAS patients at three hospitals participating in a US cardiac arrest registry from 2005 to 2011. We measured the time from arrest until first documentation of "awakening", defined as following commands purposefully.
We included 194 consecutive TH-treated PCAS patients; mean age was 57±16 years; 59% were male; 40% had an initial shockable rhythm. Mean cooling duration was 24±8h and mean rewarming time was 14±13h. Survival to discharge was 44%, with 78% of these discharged with a good neurologic outcome. Of the 85 patients who awakened, median time to awakening was 3.2 days (IQR 2.2, 4.5) post-cardiac arrest. Median time to awakening for a patient discharged in good neurological condition was 2.8 days (IQR 2.0, 4.5) vs. 4.0 days (IQR 3.5, 7.6) for those who survived to discharge without a good neurological outcome (p=0.035). There was no significant association between initial rhythm, renal insufficiency, paralytic use, post-arrest seizure, or location of arrest and time to awakening.
In TH-treated PCAS patients, time to awakening after resuscitation was highly variable and often longer than three days. Earlier awakening was associated with better neurologic status at hospital discharge.
研究表明，治疗性低温（therapeutic hypothermia，TH）可改善心脏骤停后昏迷综合征（Post-Cardiac Arrest Syndrome，PCAS）患者的预后。目前尚不清楚这些患者在心脏骤停后需要多长时间才能恢复神经反应能力。我们旨在确定心脏骤停后患者觉醒的时间以及与这种反应能力相关的时间因素。
我们对 2005 年至 2011 年期间参与美国心脏骤停登记处的三家医院中接受 TH 治疗的连续 PCAS 患者进行了回顾性图表审查。我们测量了从心脏骤停到首次记录“觉醒”的时间，定义为有目的地听从指令。
我们纳入了 194 例接受 TH 治疗的连续 PCAS 患者；平均年龄为 57±16 岁；59%为男性；40%存在初始可除颤节律。平均冷却时间为 24±8 小时，平均复温时间为 14±13 小时。出院时的存活率为 44%，其中 78%出院时神经功能良好。在 85 例觉醒的患者中，中位觉醒时间为心脏骤停后 3.2 天（IQR 2.2，4.5）。在神经功能良好出院的患者中，中位觉醒时间为 2.8 天（IQR 2.0，4.5），而在存活但出院时神经功能不良的患者中，中位觉醒时间为 4.0 天（IQR 3.5，7.6）（p=0.035）。初始节律、肾功能不全、使用麻痹剂、心脏骤停后癫痫发作或心脏骤停部位与觉醒时间之间无显著相关性。
在接受 TH 治疗的 PCAS 患者中，复苏后觉醒的时间变化很大，通常超过 3 天。较早的觉醒与出院时更好的神经功能状态相关。
