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Clinical Predictors of Neurologic Outcome in Cardiac Arrest Patients Post Induced Hypothermia FREE TO VIEW

Bilal Safadi, MD; Chadi Hage, MD; MIchelle Deckard, RN; Timothy Ellender, MD
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Indiana University, Indianapolis, IN

Chest. 2013;144(4_MeetingAbstracts):359A. doi:10.1378/chest.1704767
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SESSION TITLE: Critical Care Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: Induced Hypothermia (IH) has become the standard of care to improve neurologic outcomes in post cardiac arrest patients. Clinical predictors of neurologic outcome have not been well elucidated. The goal of this study was to evaluate the impact of multiple clinical variables on patient outcomes.

METHODS: This was a single-center prospectively collected registry of all patients (2010-11) treated with IH who survived 24 hours post completion of therapy. Neurologic outcomes were evaluated using Cerebral Performance Category (CPC) score at discharge. We defined a CPC of 1-2 as a good neurologic outcome (GNO) and a CPC of 3-5 as poor neurologic outcome (PNO). Specific patient variables and outcome data such as: survival at discharge, ventilator free days, and hospital length of stay (LOS) were collected and analyzed. We used chi-square tests to evaluate differences in categorical variables and two-sample T-tests to look for differences in continuous variables with death and CPC at discharge. Logistic regression models were used to assess the relationships of the clinical and demographic variables.

RESULTS: We included 204 patients and GNO was seen in 85 patients (42%). Presence of underlying COPD, diabetes and seizures were associated with significant development of PNO (p=0.028, 0.023, and 0.019). There were no significant predictors of mortality. The mean age was 54.2 ± 15.5 with GNO and 59.1 ± 15.5 with PNO (p=0.026). The mean peak WBC was 14.7±6.3 for GNO and 17.2±8.8 for PNO (p=0.026). Increasing age (Regression Coefficient -0.02), peak WBC (RC -0.04) and presence of seizures (RC-0.68) were associated with decreased ventilator free days, while CAD (RC 0.53) was associated with an increase. There were no significant predictors of overall LOS.

CONCLUSIONS: Presence of COPD, diabetes, seizures, elevated WBC and age may predict poor neurologic outcome at discharge. Elevated WBC and age may predict increased ventilator days, whereas CAD may decrease ventilator days.

CLINICAL IMPLICATIONS: COPD, diabetes, seizures, leukocytosis and aging may affect clinical outcomes in post cardiac arrest induced hypothermia.

DISCLOSURE: The following authors have nothing to disclose: Bilal Safadi, Chadi Hage, MIchelle Deckard, Timothy Ellender

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