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01-07-2016 | Original

Delayed awakening after cardiac arrest: prevalence and risk factors in the Parisian registry

Authors: Marine Paul, Wulfran Bougouin, Guillaume Geri, Florence Dumas, Benoit Champigneulle, Stéphane Legriel, Julien Charpentier, Jean-Paul Mira, Claudio Sandroni, Alain Cariou

Published in: Intensive Care Medicine | Issue 7/2016

Abstract

Purpose

Although prolonged unconsciousness after cardiac arrest (CA) is a sign of poor neurological outcome, limited evidence shows that a late recovery may occur in a minority of patients. We investigated the prevalence and the predictive factors of delayed awakening in comatose CA survivors treated with targeted temperature management (TTM).

Methods

Retrospective analysis of the Parisian Region Out-of-Hospital CA Registry (2008–2013). In adult comatose CA survivors treated with TTM, sedated with midazolam and fentanyl, time to awakening was measured starting from discontinuation of sedation at the end of rewarming. Awakening was defined as delayed when it occurred after more than 48 h.

Results

A total of 326 patients (71 % male, mean age 59 ± 16 years) were included, among whom 194 awoke. Delayed awakening occurred in 56/194 (29 %) patients, at a median time of 93 h (IQR 70–117) from discontinuation of sedation. In 5/56 (9 %) late awakeners, pupillary reflex and motor response were both absent 48 h after sedation discontinuation. In multivariate analysis, age over 59 years (OR 2.1, 95 % CI 1.0–4.3), post-resuscitation shock (OR 2.6 [1.3–5.2]), and renal insufficiency at admission (OR 3.1 [1.4–6.8]) were associated with significantly higher rates of delayed awakening.

Conclusions

Delayed awakening is common among patients recovering from coma after CA. Renal insufficiency, older age, and post-resuscitation shock were independent predictors of delayed awakening. Presence of unfavorable neurological signs at 48 h after rewarming from TTM and discontinuation of sedation did not rule out recovery of consciousness in late awakeners.

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Title: Delayed awakening after cardiac arrest: prevalence and risk factors in the Parisian registry
Authors: Marine Paul
Wulfran Bougouin
Guillaume Geri
Florence Dumas
Benoit Champigneulle
Stéphane Legriel
Julien Charpentier
Jean-Paul Mira
Claudio Sandroni
Alain Cariou
Publication date: 01-07-2016
Publisher: Springer Berlin Heidelberg
Published in: Intensive Care Medicine / Issue 7/2016
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-016-4349-9

At a glance: The STEP trials

Springer Medicine

Delayed awakening after cardiac arrest: prevalence and risk factors in the Parisian registry

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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