Abstract
Aim
Target temperature management (TTM) at 32–36 °C is recommended in unconscious survivors
of cardiac arrest. This study reports awakening in the TTM-trial. Our predefined hypotheses
were that time until awakening correlates with long-term neurological outcome and
is not affected by level of TTM.
Methods
Post-hoc analysis of time until awakening after cardiac arrest, its association with
long-term (180-days) neurological outcome and predictors of late awakening (day 5
or later). The trial randomized 939 comatose survivors to TTM at 33 °C or 36 °C with strict
criteria for withdrawal of life-sustaining therapies. Administered sedation in the
treatment groups was compared. Awakening was defined as a Glasgow Coma Scale motor
score 6.
Results
496 patients had registered day of awakening in the ICU, another 43 awoke after ICU
discharge. Good neurological outcome was more common in early (275/308, 89%) vs late
awakening (142/188, 76%), p < 0.001. Awakening occurred later in TTM33 than in TTM36
(p = 0.002) with no difference in neurological outcome, or cumulative doses of sedative
drugs at 12, 24 or 48 h. TTM33 (p = 0.006), clinical seizures (p = 0.004), and lower
GCS-M on admission (p = 0.03) were independent predictors of late awakening.
Conclusion
Late awakening is common and often has a good neurological outcome. Time to awakening
was longer in TTM33 than in TTM36, this difference could not be attributed to differences
in sedative drugs administered during the first 48 h.
Abbreviations:
BMI (body mass index), CPC (cerebral performance category), CPR (Cardiopulmonary resuscitation), GCS (Glasgow Coma Scale), ICU (intensive care unit), ROSC (return of spontaneous circulation), SSEP (somatosensory evoked potentials), TTM (target temperature management), TTM33 (TTM at 33 °C), TTM36 (TTM at 36 °C), WLST (withdrawal of life-sustaining treatments)Keywords
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Article info
Publication history
Published online: January 23, 2018
Accepted:
January 18,
2018
Received in revised form:
January 12,
2018
Received:
November 23,
2017
Footnotes
☆A Spanish translated version of the abstract of this article appears as Appendix in the final online version at https://doi.org/10.1016/j.resuscitation.2018.01.027.
Identification
Copyright
© 2018 Elsevier B.V. All rights reserved.
