After suffering cardiac arrest, survivors don't always maintain full brain functioning. A simple bedside tool helps predict whether patients are likely to experience favorable neurological outcomes.
The large cohort study determined that factors including age and length of required resuscitation can successfully predict the probability of a favorable neurological outcome.
Paul S. Chan, MD, MSc, lead author and a cardiologist with Saint Luke's Medical System, found that the tool was accurate in assessing patients who had been resuscitated following in-hospital cardiac arrest.
During the study investigators reviewed the records of 42,957 cardiac arrest patients through the American Heart Association's Get With the Guidelines registry. The program was initiated to monitor and improve care related to heart failure, stroke and resuscitation.
The patients, all of whom were successfully resuscitated following in-hospital cardiac arrest, visited one of 551 U.S. hospitals between January 2000 and October 2009. Researchers randomly assigned two thirds of patients as a derivation cohort and the remainder as a validation cohort.
Rates of favorable neurological outcomes were similar, representing 25 percent from each group.
In developing the tool researchers identified nearly a dozen variables that were associated with maintaining brain function.
These included younger age, brain functioning prior to cardiac arrest, whether the cardiac arrest occurred in a monitored hospital unit, quicker resuscitation time and lack of need for mechanical ventilation, or assisted breathing.
Other factors included renal or hepatic insufficiency, development of bloodstream infection sepsis, presence of other malignant diseases, low blood pressure prior to cardiac arrest or exhibiting certain heart rhythm changes with a defibrillation time of less than two minutes.
After using the tool to assess patients, researchers found that patients in the top 10 percent had a 71 percent chance of a favorable neurological outcome. Those in the bottom 10 percent had a 3 percent change of maintaining brain function.
Researchers indicated the tool would aid doctors, patients and families in predicting the probability of a favorable neurological outcome.
The study was recently published in the Archives of Internal Medicine, a publication of the Journal of the American Medical Association.