Improvement of long-term neurologic function after sudden cardiac death and resuscitation: impact of CPR method and post-resuscitation care [abstract] Abstract uri icon
  • Introduction. The randomized, prospective, multicenter ResQTrial showed that the combination of active compression–decompression (ACD) cardiopulmonary resuscitation (CPR) plus an impedance threshold device (ITD) (ACD+ITD) resulted in a 53% improved survival to hospital discharge (HD) with favorable neurologic function as compared with standard CPR (S-CPR). Objective. Since the restoration and recovery of brain function may continue beyond HD, we hypothesized that patients with poor neurologic function at HD would have a greater likelihood of significant long-term neurologic improvement if they had been resuscitated using ACD+ITD. Further, the use of postresuscitation therapeutic hypothermia (TH) should further optimize outcomes. Methods. A post hoc analysis of ResQTrial data compared survival with favorable neurologic function at 90 days, defined as a cerebral performance category (CPC) score ¡Â 2, in patients who had poor neurologic function (CPC ¡Ã 3) at HD. Data were stratified by CPR method and use of TH. Differences in the percentage of patients who improved from CPC ¡Ã 3 at HD to CPC ¡Â 2 at 90 days were analyzed using Fisher’s exact test, with a p-value < 0.05 considered to be evidence of statistical significance. Results. There were 73 patients in the S-CPR group and 100 patients in the ACD+ITD group who survived to HD and had known CPC and TH status. At 90 days, there were 50 survivors in the S-CPR group and 77 in the ACD+ITD group with known CPC and TH status. There was an overall twofold increase in the percentage of patients who improved from CPC = 3 at HD to CPC = 2 at 90 days in the ACD+ITD group (48.0%, 12/25) compared with the S-CPR group (21.0%, 4/19), but the difference was not statistically significant (p = 0.113). Among patients receiving TH, however, there was a sixfold increase associated with ACD+ITD with TH (69.2%, 9/13) vs. S-CPR with TH (11.1%, 1/9) that was significant (p = 0.012). Conclusions. In patients with poor neurologic function at hospital discharge, ACD+ITD with TH resulted in a sixfold improvement in neurologic function by 90 days, compared with SCPR with TH. These observations underscore the importance of longer-term follow-up, beyond HD, when evaluating new methods of CPR and postresuscitation care.

  • publication date
  • 2012
  • published in
  • Drugs and Drug Therapy
  • Emergency Medicine
  • Myocardial Infarction
  • Prospective Studies
  • Randomized Controlled Trials
  • Resuscitation
  • Additional Document Info
  • 16
  • issue
  • 1