Oddo et al evaluated patients who are comatose following cardiac arrest. They identified prognostic factors predictive of outcome that can help select patients who may benefit from hypothermia. The authors are from Lausanne University in Switzerland.
Patients were treated with hypothermia to 33°C +/- 1°C. Patients included those with and without ventricular fibrillation and those with and without shock.
The main prognostic factor was the time from collapse to the return of spontaneous circulation (ROSC). 66% of patients with a time to ROSC <= 25 minutes survived.
Time to ROSC
Survival
< 15 minutes
excellent (almost 100%)
15 to 25 minutes
fair (most survive but some fatalities)
> 25 minutes
poor (3%)
Another parameter was the plasma lactate level at hospital.
Plasma Lactate
Survival
< 6 mmol/L
excellent (almost 100%)
6 to 10 mmol/L
fair (most survive)
10.1 to 13 mmol/L
guarded (most do not survive)
> 13 mmol/L
poor (very low)
Of those who survived, a higher percentage of patients achieved a good neurologic outcome after hypothermia than with normothermia.
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