Association between clinical examination and outcome after cardiac arrest

Background

Neurologic prognostication after cardiac arrest relies on clinical examination findings derived before the advent of therapeutic hypothermia (TH). We measured the association between clinical examination findings at hospital arrival, 24, and 72 h after cardiac arrest in a modern intensive care unit setting.

Methods

Between 1/1/2005 and 3/31/2009, hospital charts were reviewed in 272 subjects for neurologic examination findings (Glasgow Coma Score - motor examination, pupil response, corneal response) at hospital arrival, 24, and 72 h following cardiac arrest. Primary outcome was survival to hospital discharge. Secondary outcome was “good outcome,” defined as discharge to home or acute rehabilitation facility.

Results

Mean age was 61 years; 155 (57%) were male. Most were treated with TH (N = 161; 59%) and 100 subjects (37%) were in ventricular fibrillation/ventricular tachycardia. Out-of-hospital cardiac arrest was common (N = 169; 62%). Ninety-one (33%) survived, with 54 (20%) experiencing a good outcome.In subjects with a GCS Motor score ≤3 at 24 and 72 h survival was 17% (13/76; 95% CI 7.9-26.2%) and 20% (6/27; 95% CI 6.3-33.6%), respectively. Subjects with a GCS Motor score ≤2 at 24 and 72 h survived in 14% (9/66; 95% CI 4.6-22.6%) and 18% (6/33; 95% CI 3.5-32.8%), respectively. Absent pupil reactivity on arrival did not exclude survival (7/65; 11%; 95% CI 2.4-19%). A lack of pupil reactivity or corneal response at 72 h was associated with death (pupil: 0/17; 95% CI 0, 2.9%; corneal: 0/21; 95% CI 0, 2.4%).

Conclusions

GCS Motor score ≤3 or ≤2 at 24 or 72 h following cardiac arrest does not exclude survival or good outcome. However, absent pupil or corneal response at 72 h appears to exclude survival and good outcome.