Sinus bradycardia during hypothermia in comatose survivors of out-of-hospital cardiac arrest: a new early marker of favorable outcome?
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Sinus bradycardia during hypothermia in comatose survivors of out-of-hospital cardiac arrest : a new early marker of favorable outcome? / Thomsen, Jakob Hartvig; Hassager, Christian; Bro-Jeppesen, John; Søholm, Helle; Nielsen, Niklas; Wanscher, Michael; Køber, Lars; Pehrson, Steen; Kjaergaard, Jesper.
In: Resuscitation, Vol. 89, 04.2015, p. 36-42.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Sinus bradycardia during hypothermia in comatose survivors of out-of-hospital cardiac arrest
T2 - a new early marker of favorable outcome?
AU - Thomsen, Jakob Hartvig
AU - Hassager, Christian
AU - Bro-Jeppesen, John
AU - Søholm, Helle
AU - Nielsen, Niklas
AU - Wanscher, Michael
AU - Køber, Lars
AU - Pehrson, Steen
AU - Kjaergaard, Jesper
N1 - Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
PY - 2015/4
Y1 - 2015/4
N2 - BACKGROUND: Bradycardia is a common finding in patients undergoing therapeutic hypothermia (TH) following out-of-hospital cardiac arrest (OHCA), presumably as a normal physiological response to low body temperature. We hypothesized that a normal physiological response with sinus bradycardia (SB) indicates less neurological damage and therefore would be associated with lower mortality.METHODS: We studied 234 consecutive comatose survivors of OHCA with presumed cardiac etiology and shockable primary rhythm, who underwent a full 24-h TH-protocol (33°C) at a tertiary heart center (years: 2004-2010). Primary endpoint was 180-day mortality; secondary endpoint was favorable neurological outcome (180-day cerebral performance category: 1-2).RESULTS: SB, defined as sinus rhythm <50 beats per minute during TH, was present in 115 (49%) patients. Baseline characteristics including sex, witnessed arrest, bystander cardiopulmonary resuscitation and time to return of spontaneous circulation were not different between SB- and no-SB patients. However, SB-patients were younger, 57±14 vs. 63±14 years, p<0.001 and less frequently had known heart failure (7% vs. 20%, p<0.01). Patients experiencing SB during the hypothermia phase of TH had a 17% 180-day mortality rate compared to 38% in no-SB patients (p<0.001), corresponding to a 180-day hazard ratio (HRadjusted=0.45 (0.23-0.88, p=0.02)) in the multivariable analysis. Similarly, SB during hypothermia was directly associated with lower odds of unfavorable neurological outcome (ORunadjusted=0.42 (0.23-0.75, p<0.01).CONCLUSION: Sinus bradycardia during therapeutic hypothermia is independently associated with a lower 180-day mortality rate and may thus be a novel, early marker of favorable outcome in comatose survivors of OHCA.
AB - BACKGROUND: Bradycardia is a common finding in patients undergoing therapeutic hypothermia (TH) following out-of-hospital cardiac arrest (OHCA), presumably as a normal physiological response to low body temperature. We hypothesized that a normal physiological response with sinus bradycardia (SB) indicates less neurological damage and therefore would be associated with lower mortality.METHODS: We studied 234 consecutive comatose survivors of OHCA with presumed cardiac etiology and shockable primary rhythm, who underwent a full 24-h TH-protocol (33°C) at a tertiary heart center (years: 2004-2010). Primary endpoint was 180-day mortality; secondary endpoint was favorable neurological outcome (180-day cerebral performance category: 1-2).RESULTS: SB, defined as sinus rhythm <50 beats per minute during TH, was present in 115 (49%) patients. Baseline characteristics including sex, witnessed arrest, bystander cardiopulmonary resuscitation and time to return of spontaneous circulation were not different between SB- and no-SB patients. However, SB-patients were younger, 57±14 vs. 63±14 years, p<0.001 and less frequently had known heart failure (7% vs. 20%, p<0.01). Patients experiencing SB during the hypothermia phase of TH had a 17% 180-day mortality rate compared to 38% in no-SB patients (p<0.001), corresponding to a 180-day hazard ratio (HRadjusted=0.45 (0.23-0.88, p=0.02)) in the multivariable analysis. Similarly, SB during hypothermia was directly associated with lower odds of unfavorable neurological outcome (ORunadjusted=0.42 (0.23-0.75, p<0.01).CONCLUSION: Sinus bradycardia during therapeutic hypothermia is independently associated with a lower 180-day mortality rate and may thus be a novel, early marker of favorable outcome in comatose survivors of OHCA.
KW - Adult
KW - Aged
KW - Bradycardia
KW - Coma
KW - Denmark
KW - Female
KW - Humans
KW - Hypothermia, Induced
KW - Male
KW - Middle Aged
KW - Out-of-Hospital Cardiac Arrest
KW - Outcome Assessment (Health Care)
KW - Prevalence
KW - Retrospective Studies
KW - Survival Rate
U2 - 10.1016/j.resuscitation.2014.12.031
DO - 10.1016/j.resuscitation.2014.12.031
M3 - Journal article
C2 - 25619443
VL - 89
SP - 36
EP - 42
JO - Resuscitation
JF - Resuscitation
SN - 0300-9572
ER -
ID: 162754687