Outcomes of Comatose Post-Cardiac Arrest Patients

Outcomes of Comatose Post-Cardiac Arrest Patients: a Descriptive Study INTRODUCTION METHODS Approximately 80% of resuscitated cardiac arrest patients do not immediately regain consciousness. The longitudinal objective of our work is to develop a noninvasive tool to estimate likelihood of recovery of consciousness. The current objective is to examine outcomes of a cohort of 100 comatose patients. Chart review was performed of 100 patients at Boston Medical Center (BMC), 18-90 years old, who presented after cardiac arrest with at least 24 hours of EEG within 48 hours of arrest. Exclusion criteria included ophthalmoplegia, head trauma, or dementia. BMC’s Clinical Data Warehouse extracted clinical data from their patient database. Outcomes were determined by available neurology department cardiac arrest consult notes. Chi-squared analysis (df=1) was performed to measure association between two outcomes (eyes opening to stimuli by the last exam and following commands by the last exam), some comorbidities (status epilepticus, heart failure, diabetes, polysubstance use), and demographics (such as race (white or black), sex, and age, respectively). RESULTS Pupillary Reflex 79.6% (74/93)* at first exam 85.0% (85/100) within 2 weeks 85.0% (85/100) at last exam Figure 1: Number of patients with at least one pupillary reflex at their first exam, within 2 weeks of cardiac arrest, and at their last exam. Corneal Reflex 45.7% (43/94)* at first exam 75.0% (75/100) within 2 weeks 76.0% (76/100) at last exam Figure 2: Number of patients with at least one corneal reflex at their first exam, within 2 weeks of cardiac arrest, and at their last exam. Eyes Opening to Stimuli 10.6% (10/94)* at first exam 43.0% (43/100) within 2 weeks 45.0% (45/100) at last exam Follows Commands 3.5% (3/86)* at first exam 21.0% (21/100) within 2 weeks 23.0% (23/100) at last exam Figure 3: Number of patients with eyes opening to stimuli at their first exam, within 2 weeks of cardiac arrest, and at their last exam. Figure 4: Number of patients following commands at their first exam, within 2 weeks of cardiac arrest, and at their last exam. *patients excluded for missing data on first exam Baseline Characteristics Figure 7: Flowchart of the Study Initial Screen from BMC patient database (N=112) Patients admitted to Boston Medical Center, 18-90 years old, who presented after cardiac arrest with at least 24 hours of EEG within 48 hours of arrest* Exclusion Criteria: (n=11) 1) Ophthalmoplegia (n=0) 2) Head Trauma (n=6) 3) Dementia (n=5) *For further study of prognostic models. Figure 5: Time in days from cardiac arrest to positive eyes opening to stimuli, pupillary reflex, corneal reflex, and following commands. Median time to eye opening was 2 days (IQR=2 days). Median time to at least one pupillary reflex was 1 day (IQR=1 day). Median time to at least one corneal reflex was 1 day (IQR=2.25 days). Median time to following commands was 5 days (IQR=7.5 days). Table 2. Characteristic Associations With Outcomes by Last Exam Clinical Data Warehouse Sample (N=101) Included Data (N=100) 1) Patient profiles 2) Problems lists 3) Admission diagnoses 4) Neurology cardiac arrest consult and progres notes Incomplete Data: (n=1) 1) no physical exam data Cleaned Data (N=100) 1) Race, sex, age 2) Comorbidities 3) Outcomes Figure 6: Best total GCS outcome distribution (n=100). CONCLUSIONS Almost 80% of our sample had at least one pupillary reflex on first exam, suggesting a potentially useful clinical variable for further study. None of our analyzed comorbidities or demographic factors had evidence of association with eyes opening to stimuli or following commands by last exam. Our sample is also racially diverse and balanced for sex and age, a helpful advantage when studying cardiac arrest. Understanding the demographic and clinical characteristics associated with recovery after cardiac arrest is important to inform prognostic models and guide future longitudinal studies.