Skip to main content

Advertisement

SpringerLink
Log in

Pre-existing medical comorbidity is not associated with neurological outcomes in patients undergoing targeted temperature management following cardiac arrest

  • Original Article
  • Published:
Heart and Vessels Aims and scope Submit manuscript

Abstract

The prognostic significance of chronic medical illness in comatose survivors of cardiac arrest who undergo targeted temperature management (TTM) remains largely unknown. We sought to assess the association between overall burden of pre-existing medical comorbidity and neurological outcomes in survivors of cardiac arrest undergoing TTM. We analyzed a prospectively collected cohort of 314 patients treated with TTM following cardiac arrest at a tertiary care hospital between 2007 and 2014. Overall burden of medical comorbidity was approximated with the use of the Charlson Comorbidity Index (CCI). Poor neurological outcome at hospital discharge, defined as a cerebral performance category (CPC) score >2, was the primary outcome. Secondary outcomes included death prior to hospital discharge and at 1 year following cardiac arrest. Multivariable logistic regression was used to assess the association between CCI scores and outcomes. A poor neurological outcome at hospital discharge was observed in 193 (61%) patients. One hundred and seventy-nine (57%) patients died prior to hospital discharge and a total of 195 (62%) patients had died at 1-year post-arrest. In multivariable logistic regression, elevated CCI scores were not associated with increased odds of poor neurological outcomes (OR 1.04, 95% CI 0.90–1.19, p = 0.608) or death (OR 0.99, 95% CI 0.86–1.13, p = 0.816) at hospital discharge. No association was seen between CCI scores and death at 1-year post-arrest (OR 1.09, 95% CI 0.95–1.26, p = 0.220). Increasing burden of medical comorbidity, as defined by CCI scores, is not associated with neurological outcomes or survival in patients treated with TTM.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Roger VL, Go AS, Lloyd-jones DM, Benjamin EJ, Berry JD, Borden WB, Bravata DM, Dai S, Ford ES, Fox CS, Fullerton HJ, Gillespie C, Hailpern SM, Heit JA, Howard VJ, Kissela BM, Kittner SJ, Lackland DT, Lichtman JH, Lisabeth LD, Makuc DM, Marcus GM, Marelli A, Matchar DB, Moy CS, Mozaffarian D, Mussolino ME, Nichol G, Paynter NP, Soliman EZ, Sorlie PD, Sotoodehnia N, Turan TN, Virani SS, Wong ND, Woo D, Turner MB, American Heart Association Statistics Committee and Stroke Statistics Subcommittee (2012) Executive summary: heart disease and stroke statistics–2012 update: a report from the American Heart Association. Circulation 125(1):188–197

    Article  PubMed  Google Scholar 

  2. Zheng ZJ, Croft JB, Giles WH, Mensah GA (2001) Sudden cardiac death in the United States, 1989 to 1998. Circulation 104(18):2158–2163

    Article  CAS  PubMed  Google Scholar 

  3. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, Das SR, de Ferranti S, Després JP, Fullerton HJ, Howard VJ (2016) Executive summary: heart disease and stroke statistics-2016 update: a report from the American Heart Association. Circulation 133(4):447–454

    Article  PubMed  Google Scholar 

  4. Laver S, Farrow C, Turner D, Nolan J (2004) Mode of death after admission to an intensive care unit following cardiac arrest. Intensive Care Med 30(11):2126–2128

    Article  PubMed  Google Scholar 

  5. Bernard SA, Gray TW, Buist MD, Jones BM, Silvester W, Gutteridge G, Smith K (2002) Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med 346(8):557–563

    Article  PubMed  Google Scholar 

  6. Hypothermia after Cardiac Arrest Study Group (2002) Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med 346(8):549–556

    Article  Google Scholar 

  7. Busch M, Søreide E (2011) Should advanced age be a limiting factor in providing therapeutic hypothermia to cardiac arrest survivors? A single-center observational study. Ther Hypothermia Temp Manag 1(1):29–32

    Article  PubMed  Google Scholar 

  8. Hosmane VR, Mustafa NG, Reddy VK, Reese CL, DiSabatino A, Kolm P, Hopkins JT, Weintraub WS, Rahman E (2009) Survival and neurologic recovery in patients with ST-segment elevation myocardial infarction resuscitated from cardiac arrest. J Am Coll Cardiol 53(5):409–415

    Article  PubMed  Google Scholar 

  9. Young MN, Hollenbeck RD, Pollock JS, Giuseffi JL, Wang L, Harrell FE, McPherson JA (2015) Higher achieved mean arterial pressure during therapeutic hypothermia is not associated with neurologically intact survival following cardiac arrest. Resuscitation 88:158–164

    Article  PubMed  Google Scholar 

  10. Vancouver Chelvanathan A, Allen D, Bews H, Ducas J, Minhas K, Vo M, Kass M, Ravandi A, Tam JW, Jassal DS, Hussain F (2016) Renal insufficiency and early bystander CPR predict in-hospital outcomes in cardiac arrest patients undergoing mild therapeutic hypothermia and cardiac catheterization: return of spontaneous circulation, cooling, and catheterization registry (ROSCCC Registry). Cardiol Res Pract 8798261

  11. Carew HT, Zhang W, Rea TD (2007) Chronic health conditions and survival after out-of-hospital ventricular fibrillation cardiac arrest. Heart 93(6):728–731

    Article  PubMed  PubMed Central  Google Scholar 

  12. Beesems SG, Blom MT, van der Pas MH, Hulleman M, van de Glind EM, van Munster BC, Tijssen JG, Tan HL, van Delden JJ, Koster RW (2015) Comorbidity and favorable neurologic outcome after out-of-hospital cardiac arrest in patients of 70 years and older. Resuscitation 94:33–39

    Article  PubMed  Google Scholar 

  13. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG (2009) Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 42(2):377–381

    Article  PubMed  Google Scholar 

  14. Charlson ME, Pompei P, Ales KL, Mackenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40(5):373–383

    Article  CAS  PubMed  Google Scholar 

  15. Becker LB, Aufderheide TP, Geocadin RG, Callaway CW, Lazar RM, Donnino MW, Nadkarni VM, Abella BS, Adrie C, Berg RA, Merchant RM (2011) Primary outcomes for resuscitation science studies: a consensus statement from the American Heart Association. Circulation 124(19):2158–2177

    Article  PubMed  PubMed Central  Google Scholar 

  16. StataCorp. (2015) Stata statistical software: release 14. StataCorp LP, College Station

    Google Scholar 

  17. De vos R, Koster RW, De haan RJ, Oosting H, Lampe-schoenmaeckers AJ (1999) In-hospital cardiopulmonary resuscitation: prearrest morbidity and outcome. Arch Intern Med 159(8):845–850

    Article  CAS  PubMed  Google Scholar 

  18. Lee CC, Tsai MS, Fang CC, Chen YJ, Hui-Ming M, Huang CH, Chen WJ, Chen SC (2011) Effects of pre-arrest comorbidities on 90-day survival of patients resuscitated from out-of-hospital cardiac arrest. Emerg Med J 28(5):432–436

    Article  PubMed  Google Scholar 

  19. Ebell MH, Jang W, Shen Y, Geocadin RG (2013) Development and validation of the Good Outcome Following Attempted Resuscitation (GO-FAR) score to predict neurologically intact survival after in-hospital cardiopulmonary resuscitation. JAMA Intern Med 173(20):1872–1878

    Article  PubMed  Google Scholar 

  20. Terman SW, Shields TA, Hume B, Silbergleit R (2015) The influence of age and chronic medical conditions on neurological outcomes in out of hospital cardiac arrest. Resuscitation 89:169–176

    Article  PubMed  Google Scholar 

  21. Piscator E, Hedberg P, Göransson K, Djärv T (2016) Survival after in-hospital cardiac arrest is highly associated with the Age-Combined Charlson Co-morbidity Index in a cohort study from a two-site Swedish University Hospital. Resuscitation 99:79–83

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Vanderbilt University Medical Center, Nashville, USA

    Nirmanmoh Bhatia, Benjamin Holmes, Nyal Borges, Quinn S. Wells & John A. McPherson

  2. Massachusetts General Hospital, Boston, USA

    Michael N. Young

  3. University of California, Los Angeles, Department of Medicine, 757 Westwood Plaza, St. 7501, Los Angeles, CA, 90095-7417, USA

    Arash Nayeri

Authors
  1. Arash Nayeri
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nirmanmoh Bhatia
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Benjamin Holmes
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nyal Borges
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Michael N. Young
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Quinn S. Wells
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. John A. McPherson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Arash Nayeri.

Ethics declarations

Conflict of interest

The authors declare no conflicts of interest. The authors disclose no relationships within the industry or any financial interests that may bias the results reported here.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nayeri, A., Bhatia, N., Holmes, B. et al. Pre-existing medical comorbidity is not associated with neurological outcomes in patients undergoing targeted temperature management following cardiac arrest. Heart Vessels 32, 1358–1363 (2017). https://doi.org/10.1007/s00380-017-1005-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00380-017-1005-4

Keywords

Search

Navigation