Cardiac arrest is the pause of usual circulation of the blood due to malfunction of the heart to contract successfully. A new study by University of Pittsburgh School of Medicine reveal that traditional approaches for evaluating patients after cardiac arrest may minimize their chances for survival and good outcomes.
Cardiac arrest results in about 350,000 deaths per year. Presently physicians examine pupil response, corneal reflexes and motor response to decide a patient’s forecast after efforts to resume the heart. Experts viewed the neurologic examination findings for 272 cardiac arrest patients on arrival at the hospital 24 hours later and 72 hours later.
Lead author Jon C. Rittenberger, M.D., M.S., assistant professor of emergency medicine at Pitt quotes, “The care of cardiac arrest patients has improved dramatically in recent years. Unfortunately, the neurological exams that are used to provide a prognosis for these patients appear inadequate, and it’s time to re-examine their predictive value.”
Participants enlisted for the study were mostly men and their average age was 61. Most of them were treated with therapeutic hypothermia that cools the body of a comatose to restrict brain injury and other organ damage. They identified that 33 percent of the patients survived and 20 percent experienced a good result that was discharge to home or acute rehabilitation facility.
The link between good outcomes and exam findings did not differ between those who were treated with or without therapeutic hypothermia. Participants with weak motor examination scores on neurologic exams after 24 and 72 hours displayed survival rates that were greater as compared to what clinicians would usually predict.
Dr. Rittenberger shares, “The good news is that advances in care for cardiac arrest patients appear to be improving survival rates and positive outcomes. In light of these changes, we need to re-evaluate and expand our tools for providing a prognosis to patients and their families.”
Experts observed both at 24 and 72 hours after cardiac arrest particularly at the Glasgow Coma Score (GCS) motor response. Present guidelines highlight that a GCS motor response of 3 or less is highly foretelling of death. They found that survival was 17 percent at 24 hours and 20 percent at 72 hours specifically for those with a GCS of 3 or less. The survival rate was 14 percent at 24 hours and 18 percent at 72 hours when experts used a more conservative GCS motor response of 2 or less. They also revealed that lack of pupil or corneal response at 72 hours appeared to exclude survival or good outcome.
These findings are available online in the journal Resuscitation.