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At what level of unconsciousness is mild therapeutic hypothermia indicated for out-of-hospital cardiac arrest: a retrospective, historical cohort study
Appropriate patient selection is very important when initiating mild therapeutic hypothermia (MTH) for patients following out-of-hospital cardiac arrest, and the extent of unconsciousness at implementation must be defined in such cases. However, there are no clear standards regarding the level of un...
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Published in: | Journal of intensive care 2015-09, Vol.3 (1), p.38-38, Article 38 |
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description | Appropriate patient selection is very important when initiating mild therapeutic hypothermia (MTH) for patients following out-of-hospital cardiac arrest, and the extent of unconsciousness at implementation must be defined in such cases. However, there are no clear standards regarding the level of unconsciousness at which MTH would be beneficial. The effects of MTH in patients with different degrees of unconsciousness according to the motor response score of the Glasgow Coma Scale (GCS) were investigated.
The subjects consisted of witnessed non-traumatic adult out-of-hospital cardiac arrest patients admitted to our institute from April 2002 to August 2011. The patients were divided into six groups according to the GCS motor response score: 1 (GCS M1), 2 (GCS M2), 3 (GCS M3), 4 (GCS M4), 5 (GCS M5), and 6 (GCS M6). The neurological outcome was evaluated at 30 days after hospital admission using the Cerebral Performance Category. Chi-squared Automatic Interaction Detection (CHAID) analysis was performed to estimate the threshold GCS M level where therapeutic hypothermia is indicated. Odds ratios were then calculated by multiple logistic-regression analysis using factors including GCS M5-6 and MTH.
A total of 289 patients were enrolled in this study. CHAID analysis demonstrated two points of significant increase in percentage of good recovery at 30 days after admission, dividing the GCS M categories into three groups. Patients classified with a GCS motor response score of 5 or higher had the highest percentage of good recovery. The odds ratio for good recovery (CPC1-2) was 2.901 (95 % CI 1.460-5.763, P = 0.002) for MTH, and that for GCS M5-6 was 159.835 (95 % CI 33.592-760.513, P |
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The subjects consisted of witnessed non-traumatic adult out-of-hospital cardiac arrest patients admitted to our institute from April 2002 to August 2011. The patients were divided into six groups according to the GCS motor response score: 1 (GCS M1), 2 (GCS M2), 3 (GCS M3), 4 (GCS M4), 5 (GCS M5), and 6 (GCS M6). The neurological outcome was evaluated at 30 days after hospital admission using the Cerebral Performance Category. Chi-squared Automatic Interaction Detection (CHAID) analysis was performed to estimate the threshold GCS M level where therapeutic hypothermia is indicated. Odds ratios were then calculated by multiple logistic-regression analysis using factors including GCS M5-6 and MTH.
A total of 289 patients were enrolled in this study. CHAID analysis demonstrated two points of significant increase in percentage of good recovery at 30 days after admission, dividing the GCS M categories into three groups. Patients classified with a GCS motor response score of 5 or higher had the highest percentage of good recovery. The odds ratio for good recovery (CPC1-2) was 2.901 (95 % CI 1.460-5.763, P = 0.002) for MTH, and that for GCS M5-6 was 159.835 (95 % CI 33.592-760.513, P < 0.001).
MTH may be unnecessary in patients with a GCS motor response score of 5 or higher. Consequently, because there are post cardiac arrest patients with a GCS motor response score of 4 or lower who benefit from MTH, MTH may be limited to patients with a GCS motor response score of 4 or lower.</description><identifier>ISSN: 2052-0492</identifier><identifier>EISSN: 2052-0492</identifier><identifier>DOI: 10.1186/s40560-015-0104-5</identifier><identifier>PMID: 26366291</identifier><language>eng</language><publisher>England: BioMed Central Ltd</publisher><subject>Analysis ; Cardiac arrest ; Cardiac patients ; Care and treatment ; Coma ; Health aspects ; Hypothermia ; Medical research ; Medicine, Experimental ; Methods</subject><ispartof>Journal of intensive care, 2015-09, Vol.3 (1), p.38-38, Article 38</ispartof><rights>COPYRIGHT 2015 BioMed Central Ltd.</rights><rights>Copyright BioMed Central 2015</rights><rights>Natsukawa et al. 2015</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c591t-8e45f12e3ca9b26ae7c0ee47fd9bf177c79b3d642fdc3b8462f35b6c05f407db3</citedby><cites>FETCH-LOGICAL-c591t-8e45f12e3ca9b26ae7c0ee47fd9bf177c79b3d642fdc3b8462f35b6c05f407db3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4567798/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/1772295489?pq-origsite=primo$$EHTML$$P50$$Gproquest$$Hfree_for_read</linktohtml><link.rule.ids>230,315,733,786,790,891,25783,27957,27958,37047,37048,44625,53827,53829</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26366291$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Natsukawa, Tomoaki</creatorcontrib><creatorcontrib>Sawano, Hirotaka</creatorcontrib><creatorcontrib>Natsukawa, Mai</creatorcontrib><creatorcontrib>Yoshinaga, Yuichi</creatorcontrib><creatorcontrib>Sato, Shuho</creatorcontrib><creatorcontrib>Ito, Yusuke</creatorcontrib><creatorcontrib>Otani, Takayuki</creatorcontrib><creatorcontrib>Ohba, Jiro</creatorcontrib><creatorcontrib>Hayashi, Yasuyuki</creatorcontrib><creatorcontrib>Kai, Tatsuro</creatorcontrib><title>At what level of unconsciousness is mild therapeutic hypothermia indicated for out-of-hospital cardiac arrest: a retrospective, historical cohort study</title><title>Journal of intensive care</title><addtitle>J Intensive Care</addtitle><description>Appropriate patient selection is very important when initiating mild therapeutic hypothermia (MTH) for patients following out-of-hospital cardiac arrest, and the extent of unconsciousness at implementation must be defined in such cases. However, there are no clear standards regarding the level of unconsciousness at which MTH would be beneficial. The effects of MTH in patients with different degrees of unconsciousness according to the motor response score of the Glasgow Coma Scale (GCS) were investigated.
The subjects consisted of witnessed non-traumatic adult out-of-hospital cardiac arrest patients admitted to our institute from April 2002 to August 2011. The patients were divided into six groups according to the GCS motor response score: 1 (GCS M1), 2 (GCS M2), 3 (GCS M3), 4 (GCS M4), 5 (GCS M5), and 6 (GCS M6). The neurological outcome was evaluated at 30 days after hospital admission using the Cerebral Performance Category. Chi-squared Automatic Interaction Detection (CHAID) analysis was performed to estimate the threshold GCS M level where therapeutic hypothermia is indicated. Odds ratios were then calculated by multiple logistic-regression analysis using factors including GCS M5-6 and MTH.
A total of 289 patients were enrolled in this study. CHAID analysis demonstrated two points of significant increase in percentage of good recovery at 30 days after admission, dividing the GCS M categories into three groups. Patients classified with a GCS motor response score of 5 or higher had the highest percentage of good recovery. The odds ratio for good recovery (CPC1-2) was 2.901 (95 % CI 1.460-5.763, P = 0.002) for MTH, and that for GCS M5-6 was 159.835 (95 % CI 33.592-760.513, P < 0.001).
MTH may be unnecessary in patients with a GCS motor response score of 5 or higher. Consequently, because there are post cardiac arrest patients with a GCS motor response score of 4 or lower who benefit from MTH, MTH may be limited to patients with a GCS motor response score of 4 or lower.</description><subject>Analysis</subject><subject>Cardiac arrest</subject><subject>Cardiac patients</subject><subject>Care and treatment</subject><subject>Coma</subject><subject>Health aspects</subject><subject>Hypothermia</subject><subject>Medical research</subject><subject>Medicine, Experimental</subject><subject>Methods</subject><issn>2052-0492</issn><issn>2052-0492</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>PIMPY</sourceid><recordid>eNptkt9qFDEUxgdRbFn7AN5IQBAvOjXJJJkZL4SlWBUK3uh1yCQnnZTMZE0yK_skvq5ZttZdkRDy73e-cM75quolwVeEdOJdYpgLXGPCy8Ss5k-qc4o5rTHr6dOj_Vl1kdI9xoXijej659UZFY0QtCfn1a91Rj9HlZGHLXgULFpmHeakXVjSDCkhl9DkvEF5hKg2sGSn0bjbhP15cgq52TitMhhkQ0RhyXWw9RjSxmXlkVbROKWRihFSfo8UipBjeQWd3RYu0ehSDrEoFDaMIWaU8mJ2L6pnVvkEFw_rqvp-8_Hb9ef69uunL9fr21rznuS6A8YtodBo1Q9UKGg1BmCtNf1gSdvqth8aIxi1RjdDxwS1DR-Extwy3JqhWVUfDrqbZZjAaJhzVF5uoptU3MmgnDx9md0o78JWMi7atu-KwNsHgRh-LCVHObmkwXs1QymhJC2hnDa4lHxVvf4HvQ9LnEt6hWop7Tnr-r_UnfIg3WxD-VfvReWaMyI61vE9dfUfqgwDkysNBOvK_UnAm6OAEZTPYwq-tLN0-xQkB1CXNqUI9rEYBMu98-TBebI4T-6dJ3mJeXVcxceIPz5rfgM8DdZh</recordid><startdate>20150911</startdate><enddate>20150911</enddate><creator>Natsukawa, Tomoaki</creator><creator>Sawano, Hirotaka</creator><creator>Natsukawa, Mai</creator><creator>Yoshinaga, Yuichi</creator><creator>Sato, Shuho</creator><creator>Ito, Yusuke</creator><creator>Otani, Takayuki</creator><creator>Ohba, Jiro</creator><creator>Hayashi, Yasuyuki</creator><creator>Kai, Tatsuro</creator><general>BioMed Central Ltd</general><general>BioMed Central</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20150911</creationdate><title>At what level of unconsciousness is mild therapeutic hypothermia indicated for out-of-hospital cardiac arrest: a retrospective, historical cohort study</title><author>Natsukawa, Tomoaki ; Sawano, Hirotaka ; Natsukawa, Mai ; Yoshinaga, Yuichi ; Sato, Shuho ; Ito, Yusuke ; Otani, Takayuki ; Ohba, Jiro ; Hayashi, Yasuyuki ; Kai, Tatsuro</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c591t-8e45f12e3ca9b26ae7c0ee47fd9bf177c79b3d642fdc3b8462f35b6c05f407db3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Analysis</topic><topic>Cardiac arrest</topic><topic>Cardiac patients</topic><topic>Care and treatment</topic><topic>Coma</topic><topic>Health aspects</topic><topic>Hypothermia</topic><topic>Medical research</topic><topic>Medicine, Experimental</topic><topic>Methods</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Natsukawa, Tomoaki</creatorcontrib><creatorcontrib>Sawano, Hirotaka</creatorcontrib><creatorcontrib>Natsukawa, Mai</creatorcontrib><creatorcontrib>Yoshinaga, Yuichi</creatorcontrib><creatorcontrib>Sato, Shuho</creatorcontrib><creatorcontrib>Ito, Yusuke</creatorcontrib><creatorcontrib>Otani, Takayuki</creatorcontrib><creatorcontrib>Ohba, Jiro</creatorcontrib><creatorcontrib>Hayashi, Yasuyuki</creatorcontrib><creatorcontrib>Kai, Tatsuro</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of intensive care</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Natsukawa, Tomoaki</au><au>Sawano, Hirotaka</au><au>Natsukawa, Mai</au><au>Yoshinaga, Yuichi</au><au>Sato, Shuho</au><au>Ito, Yusuke</au><au>Otani, Takayuki</au><au>Ohba, Jiro</au><au>Hayashi, Yasuyuki</au><au>Kai, Tatsuro</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>At what level of unconsciousness is mild therapeutic hypothermia indicated for out-of-hospital cardiac arrest: a retrospective, historical cohort study</atitle><jtitle>Journal of intensive care</jtitle><addtitle>J Intensive Care</addtitle><date>2015-09-11</date><risdate>2015</risdate><volume>3</volume><issue>1</issue><spage>38</spage><epage>38</epage><pages>38-38</pages><artnum>38</artnum><issn>2052-0492</issn><eissn>2052-0492</eissn><notes>ObjectType-Article-1</notes><notes>SourceType-Scholarly Journals-1</notes><notes>ObjectType-Feature-2</notes><notes>content type line 23</notes><abstract>Appropriate patient selection is very important when initiating mild therapeutic hypothermia (MTH) for patients following out-of-hospital cardiac arrest, and the extent of unconsciousness at implementation must be defined in such cases. However, there are no clear standards regarding the level of unconsciousness at which MTH would be beneficial. The effects of MTH in patients with different degrees of unconsciousness according to the motor response score of the Glasgow Coma Scale (GCS) were investigated.
The subjects consisted of witnessed non-traumatic adult out-of-hospital cardiac arrest patients admitted to our institute from April 2002 to August 2011. The patients were divided into six groups according to the GCS motor response score: 1 (GCS M1), 2 (GCS M2), 3 (GCS M3), 4 (GCS M4), 5 (GCS M5), and 6 (GCS M6). The neurological outcome was evaluated at 30 days after hospital admission using the Cerebral Performance Category. Chi-squared Automatic Interaction Detection (CHAID) analysis was performed to estimate the threshold GCS M level where therapeutic hypothermia is indicated. Odds ratios were then calculated by multiple logistic-regression analysis using factors including GCS M5-6 and MTH.
A total of 289 patients were enrolled in this study. CHAID analysis demonstrated two points of significant increase in percentage of good recovery at 30 days after admission, dividing the GCS M categories into three groups. Patients classified with a GCS motor response score of 5 or higher had the highest percentage of good recovery. The odds ratio for good recovery (CPC1-2) was 2.901 (95 % CI 1.460-5.763, P = 0.002) for MTH, and that for GCS M5-6 was 159.835 (95 % CI 33.592-760.513, P < 0.001).
MTH may be unnecessary in patients with a GCS motor response score of 5 or higher. Consequently, because there are post cardiac arrest patients with a GCS motor response score of 4 or lower who benefit from MTH, MTH may be limited to patients with a GCS motor response score of 4 or lower.</abstract><cop>England</cop><pub>BioMed Central Ltd</pub><pmid>26366291</pmid><doi>10.1186/s40560-015-0104-5</doi><tpages>1</tpages><oa>free_for_read</oa></addata></record> |
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subjects | Analysis Cardiac arrest Cardiac patients Care and treatment Coma Health aspects Hypothermia Medical research Medicine, Experimental Methods |
title | At what level of unconsciousness is mild therapeutic hypothermia indicated for out-of-hospital cardiac arrest: a retrospective, historical cohort study |
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