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Hyperthermia After Cardiac Arrest Is Associated With an Unfavorable Neurologic Outcome
Andrea Zeiner, MD;
Michael Holzer, MD;
Fritz Sterz, MD;
Waltraud Schörkhuber, MD;
Philip Eisenburger, MD;
Christof Havel, MD;
Andreas Kliegel, MD;
Anton N. Laggner, MD
Arch Intern Med. 2001;161:2007-2012.
Background Moderate elevation of brain temperature, when present during or after
ischemia, may markedly worsen the resulting injury.
Objective To evaluate the impact of body temperature on neurologic outcome after
successful cardiopulmonary resuscitation.
Methods In patients who experienced a witnessed cardiac arrest of presumed cardiac
cause, the temperature was recorded on admission to the emergency department
and after 2, 4, 6, 12, 18, 24, 36, and 48 hours. The lowest temperature within
4 hours and the highest temperature during the first 48 hours after restoration
of spontaneous circulation were recorded and correlated to the best-achieved
cerebral performance categories' score within 6 months.
Results Over 43 months, of 698 patients, 151 were included. The median age was
60 years (interquartile range, 53-69 years); the estimated median no-flow
duration was 5 minutes (interquartile range, 0-10 minutes), and the estimated
median low-flow duration was 14.5 minutes (interquartile range, 3-25 minutes).
Forty-two patients (28%) underwent bystander-administered basic life support.
Within 6 months, 74 patients (49%) had a favorable functional neurologic recovery,
and a total of 86 patients (57%) survived until 6 months after the event.
The temperature on admission showed no statistically significant difference
(P = .39). Patients with a favorable neurologic recovery
showed a higher lowest temperature within 4 hours (35.8°C [35.0°C-36.1°C]
vs 35.2°C [34.5°C-35.7°C]; P = .002)
and a lower highest temperature during the first 48 hours after restoration
of spontaneous circulation (37.7°C [36.9°C-38.6°C] vs 38.3°C
[37.8°C-38.9°C]; P<.001) (data are given
as the median [interquartile range]). For each degree Celsius higher than
37°C, the risk of an unfavorable neurologic recovery increases, with an
odds ratio of 2.26 (95% confidence interval, 1.24-4.12).
Conclusion Hyperthermia is a potential factor for an unfavorable functional neurologic
recovery after successful cardiopulmonary resuscitation.
From the University Clinic of Emergency Medicine, Medical School, University
of Vienna, Vienna, Austria.
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