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

• Published in: Heart and vessels Vol. 32; no. 11; pp. 1358 - 1363
• Main Authors: Nayeri, Arash, Bhatia, Nirmanmoh, Holmes, Benjamin, Borges, Nyal, Young, Michael N., Wells, Quinn S., McPherson, John A.
• Format: Journal Article
• Language: English
• Published: Tokyo Springer Japan 01-11-2017; Springer Nature B.V
• Subjects: Aged; Biomedical Engineering and Bioengineering; Cardiac arrest; Cardiac Surgery; Cardiology; Cardiopulmonary resuscitation; Cardiopulmonary Resuscitation - methods; Cause of Death - trends; Coma; Comorbidity; Comorbidity - trends; CPR; Death; Female; Follow-Up Studies; Heart; Heart Arrest - epidemiology; Heart Arrest - physiopathology; Heart Arrest - therapy; Heart diseases; Humans; Hypothermia; Hypothermia, Induced - methods; Male; Medicine; Medicine & Public Health; Middle Aged; Mortality; Neurology; Original Article; Patients; Prognosis; Regression analysis; Retrospective Studies; Stroke - diagnosis; Stroke - epidemiology; Survival Rate - trends; Temperature; Time Factors; United States - epidemiology; Vascular Surgery; Cerebral performance category (CPC); Medical comorbidity; Charlson Comorbidity Index (CCI); Targeted temperature management (TTM); Therapeutic hypothermia (TH); Cardiac arrest
• ISSN: 0910-8327; 1615-2573
• DOI: 10.1007/s00380-017-1005-4

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.