Clinical Medicine II.
Bettina Nagy, Heart ans Vascular Center, Semmelweis University, Budapest Hungary
Boldizsár Kiss, MD, Heart ans Vascular Center, Semmelweis University, Budapest Hungary
Introduction: Sudden cardiac death is one of the most common causes of cardiovascular death. If the patient has undergone prolonged cardiopulmonary resuscitation or has remained in a coma, targeted temperature management (TTM) is used to treat hypoxic damage to the brain and prevent secondary damage.
Aim: Our aim was to create a score system that accurately estimates the outcome within the first 24 hours after cardiac arrest in TTM patients based on simple and easily measurable parameters.
Methods: In our retrospective study, we processed data from 103 consecutive patients who were successfully resuscitated and received TTM at our clinic between 2016 and 2020. Parameters: demographic data, initial rhythm, heart rate (HR), blood pressure, catecholamine requirement, echocardiographic-, laboratory-, and blood gas values. Our data were evaluated using simple descriptive statistics, ROC-, and Kaplan-Meier analysis.
Results: Based on early mortality, two groups were created: survivor (S)/non-survivor (NS). The best prognostic markers selected for the score system based on AUC for 30-day mortality were HR above 70 beats/min, systolic blood pressure below 110 mmHg, GFR below 45 ml/min /1.73 m2, TAPSE below 15 mm and BE below -8.5 mmol/l. Mortality-enhancing variables are also non-shockable rhythm (S:24.4%, NS: 8.6%, p=0.03) and noradrenaline (NA) requirement (S:0.167 µg/kg/min, NS: 0.034 µg/kg/min, p=0.029). If the studied variable exceeded the diagnostic threshold, the patient developed NA demand or had non-shockable initial rhythm received 1 point. The maximum score was 7. The mortality is 9% at 0 points and 85% at 7 points.
Conclusion: It can be concluded that the scoring system we have developed may be suitable for early risk assessment of patients receiving TTM as part of primary post-resuscitation care. As the score increases, so does the 30-day mortality.
Funding: The lack of expected decrease in HR correlates with lower expected survival. It was shown that the arterial blood pressure recorded during TTM also plays a central role in determining the outcome, so it may be a bases of a new “target-oriented therapeutic objective” during intensive care after resuscitation.