Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Heart rate may predict survival and brain function in comatose cardiac arrest survivors

20.10.2014

Researchers may have developed a way to potentially assist prognostication in the first 24 hours after out-of-hospital cardiac arrest (OHCA) when patients are still in a coma. Their findings are revealed today at Acute Cardiovascular Care 2014 by Dr Jakob Hartvig Thomsen from Copenhagen, Denmark.

Acute Cardiovascular Care is the annual meeting of the Acute Cardiovascular Care Association (ACCA) of the European Society of Cardiology (ESC) and takes place 18-20 October in Geneva, Switzerland.


This figure shows the 180-day mortality rate by experience of sinus bradycardia during therapeutic hypothermia.

Credit: Jakob Hartvig Thomsen

Dr Thomsen said: "When we talk to relatives and friends immediately after a cardiac arrest we often tell them that we're not able to say much about the prognosis for their Dad, Mom, friend, etc, for the next 3 to 4 days. This is incredibly distressing and loved ones are desperate for more information."

He added: "Therapeutic hypothermia is used in comatose survivors of OHCA to protect them from brain damage. Current recommendations say that prognostication should not be made until 72 hours after hypothermia when patients have returned to normothermia and the sedation has worn off.1 The prognostic tools presently available are not reliable until after this 72 hour period."

Dr Thomsen continued: "During hypothermia some patients lower their heart rate, which is called bradycardia. We hypothesised that this is a normal physiological reaction and that these patients may have less severe brain injury after their arrest and therefore lower mortality."

The study was conducted in the intensive care unit at Copenhagen University Hospital during 2004-2010 and was supported by the EU Interreg IV A programme. It included 234 comatose survivors of OHCA who underwent the hospital's standard 24 hour therapeutic hypothermia protocol. Heart rhythm was measured hourly and sinus bradycardia (defined as less than 50 heart beats per minute) was used to stratify the patients. The primary endpoint was 180 day mortality.

The investigators found that patients who experienced sinus bradycardia during therapeutic hypothermia had a 17% 180 day mortality rate compared to 38% in those with no sinus bradycardia (p<0.001) (figure 1), with a hazard ratio (HR) of 0.38. Sinus bradycardia during therapeutic hypothermia remained an independent predictor of lower 180 day mortality with a HR of 0.51 after adjusting for known confounding factors including sex, age, comorbidity, witnessed arrest and bystander CPR.

Dr Thomsen said: "Patients with sinus bradycardia during therapeutic hypothermia had a 50-60% lower mortality rate at 180 days than those with no sinus bradycardia. We also found that sinus bradycardia was directly associated with a better neurological status 180 days after the arrest."

Few patients are in sinus bradycardia when they arrive at the intensive care unit (a period called the induction phase). However the proportion rises during hypothermia to almost 50%, and then declines during the rewarming phase.

Dr Thomsen said: "We speculated that this proportion of patients who develop sinus bradycardia during hypothermia would have better brain function and a lower mortality rate, and that was what we found. "

He added: "Now when we observe that a patient experiences sinus bradycardia below 50 beats per minute within the first 24 hours we can tell families that their relative may have a chance of recovery."

Dr Thomsen continued: "There is a lot of discussion about defining criteria to identify patients we should stop treating when a vegetative state is inevitable. We shouldn't give up on patients who still have a chance so this is an area in which we need to be very certain. Our findings provide an early marker of patients who may do well. Hopefully in the future, together with other tools, we will be able to differentiate between those with a very good or very poor prognosis so we can prioritise intensive care resources."

He concluded: "We are currently validating our findings by conducting the same analysis in the 950 patients included in the Targeted Temperature Management trial which was conducted in 36 intensive care units."

Jacqueline Partarrieu | Eurek Alert!
Further information:
http://www.escardio.org

More articles from Health and Medicine:

nachricht Penn vet research identifies new target for taming Ebola
12.01.2017 | University of Pennsylvania

nachricht The strange double life of Dab2
10.01.2017 | University of Miami Miller School of Medicine

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Interfacial Superconductivity: Magnetic and superconducting order revealed simultaneously

Researchers from the University of Hamburg in Germany, in collaboration with colleagues from the University of Aarhus in Denmark, have synthesized a new superconducting material by growing a few layers of an antiferromagnetic transition-metal chalcogenide on a bismuth-based topological insulator, both being non-superconducting materials.

While superconductivity and magnetism are generally believed to be mutually exclusive, surprisingly, in this new material, superconducting correlations...

Im Focus: Studying fundamental particles in materials

Laser-driving of semimetals allows creating novel quasiparticle states within condensed matter systems and switching between different states on ultrafast time scales

Studying properties of fundamental particles in condensed matter systems is a promising approach to quantum field theory. Quasiparticles offer the opportunity...

Im Focus: Designing Architecture with Solar Building Envelopes

Among the general public, solar thermal energy is currently associated with dark blue, rectangular collectors on building roofs. Technologies are needed for aesthetically high quality architecture which offer the architect more room for manoeuvre when it comes to low- and plus-energy buildings. With the “ArKol” project, researchers at Fraunhofer ISE together with partners are currently developing two façade collectors for solar thermal energy generation, which permit a high degree of design flexibility: a strip collector for opaque façade sections and a solar thermal blind for transparent sections. The current state of the two developments will be presented at the BAU 2017 trade fair.

As part of the “ArKol – development of architecturally highly integrated façade collectors with heat pipes” project, Fraunhofer ISE together with its partners...

Im Focus: How to inflate a hardened concrete shell with a weight of 80 t

At TU Wien, an alternative for resource intensive formwork for the construction of concrete domes was developed. It is now used in a test dome for the Austrian Federal Railways Infrastructure (ÖBB Infrastruktur).

Concrete shells are efficient structures, but not very resource efficient. The formwork for the construction of concrete domes alone requires a high amount of...

Im Focus: Bacterial Pac Man molecule snaps at sugar

Many pathogens use certain sugar compounds from their host to help conceal themselves against the immune system. Scientists at the University of Bonn have now, in cooperation with researchers at the University of York in the United Kingdom, analyzed the dynamics of a bacterial molecule that is involved in this process. They demonstrate that the protein grabs onto the sugar molecule with a Pac Man-like chewing motion and holds it until it can be used. Their results could help design therapeutics that could make the protein poorer at grabbing and holding and hence compromise the pathogen in the host. The study has now been published in “Biophysical Journal”.

The cells of the mouth, nose and intestinal mucosa produce large quantities of a chemical called sialic acid. Many bacteria possess a special transport system...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

12V, 48V, high-voltage – trends in E/E automotive architecture

10.01.2017 | Event News

2nd Conference on Non-Textual Information on 10 and 11 May 2017 in Hannover

09.01.2017 | Event News

Nothing will happen without batteries making it happen!

05.01.2017 | Event News

 
Latest News

Water - as the underlying driver of the Earth’s carbon cycle

17.01.2017 | Earth Sciences

Interfacial Superconductivity: Magnetic and superconducting order revealed simultaneously

17.01.2017 | Materials Sciences

Smart homes will “LISTEN” to your voice

17.01.2017 | Architecture and Construction

VideoLinks
B2B-VideoLinks
More VideoLinks >>>