Medical ICU, Cochin Hospital, AP-HP, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France.
Paris Cardiovascular Research Center, INSERM U970, Paris, France.
Intensive Care Med. 2016 Jul;42(7):1128-36. doi: 10.1007/s00134-016-4349-9. Epub 2016 Apr 20.
Although prolonged unconsciousness after cardiac arrest (CA) is a sign of poor neurological outcome, limited evidence shows that a late recovery may occur in a minority of patients. We investigated the prevalence and the predictive factors of delayed awakening in comatose CA survivors treated with targeted temperature management (TTM).
Retrospective analysis of the Parisian Region Out-of-Hospital CA Registry (2008-2013). In adult comatose CA survivors treated with TTM, sedated with midazolam and fentanyl, time to awakening was measured starting from discontinuation of sedation at the end of rewarming. Awakening was defined as delayed when it occurred after more than 48 h.
A total of 326 patients (71 % male, mean age 59 ± 16 years) were included, among whom 194 awoke. Delayed awakening occurred in 56/194 (29 %) patients, at a median time of 93 h (IQR 70-117) from discontinuation of sedation. In 5/56 (9 %) late awakeners, pupillary reflex and motor response were both absent 48 h after sedation discontinuation. In multivariate analysis, age over 59 years (OR 2.1, 95 % CI 1.0-4.3), post-resuscitation shock (OR 2.6 [1.3-5.2]), and renal insufficiency at admission (OR 3.1 [1.4-6.8]) were associated with significantly higher rates of delayed awakening.
Delayed awakening is common among patients recovering from coma after CA. Renal insufficiency, older age, and post-resuscitation shock were independent predictors of delayed awakening. Presence of unfavorable neurological signs at 48 h after rewarming from TTM and discontinuation of sedation did not rule out recovery of consciousness in late awakeners.
尽管心脏骤停（CA）后长时间昏迷是神经预后不良的标志，但有限的证据表明少数患者可能会出现延迟恢复。我们研究了接受目标温度管理（TTM）治疗的昏迷性 CA 幸存者中延迟苏醒的发生率和预测因素。
对 2008-2013 年巴黎地区院外 CA 登记处（Parisian Region Out-of-Hospital CA Registry）的回顾性分析。在接受 TTM 治疗并接受咪达唑仑和芬太尼镇静的成年昏迷性 CA 幸存者中，从复温结束时停止镇静开始测量苏醒时间。当苏醒发生在超过 48 小时后时，定义为延迟苏醒。
共纳入 326 名患者（71%为男性，平均年龄 59±16 岁），其中 194 名苏醒。194 名苏醒患者中，56 名（29%）出现延迟苏醒，从镇静停止开始中位数时间为 93 小时（IQR 70-117）。在 5/56（9%）延迟苏醒者中，在镇静停止后 48 小时，瞳孔反射和运动反应均消失。多变量分析显示，年龄超过 59 岁（OR 2.1，95%CI 1.0-4.3）、复苏后休克（OR 2.6 [1.3-5.2]）和入院时肾功能不全（OR 3.1 [1.4-6.8]）与延迟苏醒发生率显著升高相关。
CA 后从昏迷中恢复的患者中，延迟苏醒很常见。肾功能不全、年龄较大和复苏后休克是延迟苏醒的独立预测因素。在 TTM 复温并停止镇静后 48 小时出现不良神经体征并不排除晚期苏醒者意识恢复。
