Advanced

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

Lybeck, Anna LU ; Cronberg, Tobias LU ; Aneman, Anders; Hassager, Christian; Horn, Janneke; Hovdenes, Jan; Kjærgaard, Jesper; Kuiper, Michael; Wanscher, Michael and Stammet, Pascal, et al. (2018) In Resuscitation
Abstract

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.... (More)

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.

(Less)
Please use this url to cite or link to this publication:
author
, et al. (More)
(Less)
organization
publishing date
type
Contribution to journal
publication status
epub
subject
keywords
Awakening, Cardiac arrest, Sedation, Target temperature management, Withdrawal
in
Resuscitation
publisher
Elsevier
external identifiers
  • scopus:85041577290
ISSN
0300-9572
DOI
10.1016/j.resuscitation.2018.01.027
language
English
LU publication?
yes
id
6fd2670b-bd68-45fb-8447-7f64b1d4d458
date added to LUP
2018-02-23 08:40:40
date last changed
2018-09-16 04:53:26
@article{6fd2670b-bd68-45fb-8447-7f64b1d4d458,
  abstract     = {<p>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 &lt; 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.</p>},
  author       = {Lybeck, Anna and Cronberg, Tobias and Aneman, Anders and Hassager, Christian and Horn, Janneke and Hovdenes, Jan and Kjærgaard, Jesper and Kuiper, Michael and Wanscher, Michael and Stammet, Pascal and Wise, Matthew P. and Nielsen, Niklas and Ullén, Susann and Friberg, Hans},
  issn         = {0300-9572},
  keyword      = {Awakening,Cardiac arrest,Sedation,Target temperature management,Withdrawal},
  language     = {eng},
  publisher    = {Elsevier},
  series       = {Resuscitation},
  title        = {Time to awakening after cardiac arrest and the association with target temperature management},
  url          = {http://dx.doi.org/10.1016/j.resuscitation.2018.01.027},
  year         = {2018},
}