eISSN: 1896-9151
ISSN: 1734-1922
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abstract:
Letter to the Editor

Predictors of long-term survival in patients treated with targeted temperature management after cardiac arrest

Jiří Bonaventura, David Alan, Jiří Vejvoda, Markéta Pavlíková, Josef Veselka

Online publish date: 2019/02/18
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Sudden cardiac arrest (CA) is a common cause of death in industrialized countries. The incidence of out-of-hospital cardiac arrest (OHCA) is estimated at 350,000 to 700,000 patients in Europe every year [1]. The survival rate of OHCA used to be very poor, but advances in cardiopulmonary resuscitation and post-cardiac arrest care including targeted temperature management (TTM) have improved outcomes in selected cohorts of patients [2]. Neurologic injury from cerebral hypoxia is the most common cause of death in patients with OHCA [3]. While the issue of OHCA is well described and the data are widely available, there is little evidence regarding TTM after in-hospital cardiac arrest (IHCA), and our knowledge is based mostly on the results of retrospective and observational studies [4, 5]. Whether certain subpopulations of cardiac arrest patients have greater benefit from TTM is being debated [6]. The aim of this study was to identify the independent predictors of long-term neurologically favourable survival in patients treated with TTM after CA.
The study was performed on 140 consecutive patients (29 women, mean age: 64.6 ±12.8 years), who were hospitalized between November 2006 and June 2016 in a single cardiovascular centre after successfully resuscitated CA. Both patients with OHCA and IHCA were included. All patients had return of spontaneous circulation (ROSC) for at least 20 min and were unconscious (a score of < 8 on the Glasgow Coma Scale) on admission to the hospital. All patients underwent TTM as soon as possible after admission. All patients with suspected acute coronary syndrome underwent cardiac catheterization as soon as possible, while the patients with ST-segment elevation myocardial infarction underwent emergent cardiac catheterisation with immediate percutaneous coronary intervention, when required. No emergency or urgent cardiovascular surgery was performed. An intra-aortic balloon pump (IABP) was used in 16 patients. Extracorporeal membrane oxygenation (ECMO) was used in 2 patients. All patients who survived to hospital discharge underwent regular clinical and telephonic follow-up.
The primary endpoint was long-term neurologically favourable survival. Good neurologic function was defined as a Cerebral Performance Category (CPC) of 1 or 2. Bad outcome was defined as CPC 3 to 5. A total of 136 patients were included in the statistical analysis. Four patients (all men) were lost to follow-up. Baseline characteristics of...


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