Navigate Up
UPMC/University of Pittsburgh Schools of the Health Sciences
Director
Telephone: 412-586-9777
Senior Manager
Telephone: 412-578-9193 or 412-624-3212
Patients and medical professionals may call 1-800-533-UPMC (8762) for more information.
University of Pittsburgh Schools of the Health Sciences 

Traditional Neurologic Exams Inadequate for Predicting Survival of Cardiac Arrest Patients, Pitt Study Finds

PITTSBURGH, June 23, 2010 – Traditional methods for assessing patients after cardiac arrest may be underestimating their chances for survival and good outcomes, according to a new study by University of Pittsburgh School of Medicine researchers now available online in the journal Resuscitation.

“The care of cardiac arrest patients has improved dramatically in recent years,” noted lead author Jon C. Rittenberger, M.D., M.S., assistant professor of emergency medicine at Pitt. “Unfortunately, the neurological exams that are used to provide a prognosis for these patients appear inadequate, and it’s time to re-examine their predictive value.”

Cardiac arrest results in about 350,000 deaths each year. Currently, physicians assess pupil response, corneal reflexes and motor response to determine a patient’s prognosis after resuscitation to restart the heart.

For this study, researchers retrospectively reviewed the neurologic examination findings for 272 cardiac arrest patients upon arrival at the hospital, 24 hours later and 72 hours later. Most of the subjects were men, and the mean age was 61. Most were treated with therapeutic hypothermia, which cools the body of a comatose patient to prevent brain injury and other organ damage.

The researchers found that 33 percent of the patients in the study survived, and 20 percent experienced a good outcome, defined as discharge to home or to an acute rehabilitation facility. The association between good outcomes and exam findings did not differ between those treated with or without therapeutic hypothermia. Surprisingly, even those with poor motor examination scores on neurologic exams after 24 and 72 hours showed survival rates that were higher than what clinicians traditionally would have predicted.

The researchers looked specifically at the Glasgow Coma Score (GCS) motor response, both at 24 and 72 hours after cardiac arrest. Existing guidelines suggest that a GCS motor response of 3 or less is highly predictive of mortality. Rittenberger and his team found that survival was 17 percent at 24 hours and 20 percent at 72 hours for those with a GCS of 3 or less. When the investigators used a more conservative GCS motor response of 2 or less, the survival rate was 14 percent at 24 hours and 18 percent at 72 hours.

Consistent with existing guidelines, the researchers found that a lack of pupil or corneal response at 72 hours appeared to exclude survival or good outcome.

“The good news is that advances in care for cardiac arrest patients appear to be improving survival rates and positive outcomes,” said Dr. Rittenberger. “In light of these changes, we need to re-evaluate and expand our tools for providing a prognosis to patients and their families.”

Dr. Rittenberger is supported by a grant from the National Center for Research Resources, part of the National Institutes of Health, as well as an unrestricted grant from the National Association of EMS Physicians/Zoll EMS Resuscitation Research Fellowship.

University of Pittsburgh School of Medicine

As one of the nation’s leading academic centers for biomedical research, the University of Pittsburgh School of Medicine integrates advanced technology with basic science across a broad range of disciplines in a continuous quest to harness the power of new knowledge and improve the human condition. Driven mainly by the School of Medicine and its affiliates, Pitt has ranked among the top 10 recipients of funding from the National Institutes of Health since 1997 and now ranks fifth in the nation, according to preliminary data for fiscal year 2008. Likewise, the School of Medicine is equally committed to advancing the quality and strength of its medical and graduate education programs, for which it is recognized as an innovative leader, and to training highly skilled, compassionate clinicians and creative scientists well-equipped to engage in world-class research. The School of Medicine is the academic partner of UPMC, which has collaborated with the University to raise the standard of medical excellence in Pittsburgh and to position health care as a driving force behind the region’s economy. For more information about the School of Medicine, see www.medschool.pitt.edu.

©  UPMC | Affiliated with the University of Pittsburgh Schools of the Health Sciences
Supplemental content provided by A.D.A.M. Health Solutions. All rights reserved.

For help in finding a doctor or health service that suits your needs, call the UPMC Referral Service at 412-647-UPMC (8762) or 1-800-533-UPMC (8762). Select option 1.

UPMC is an equal opportunity employer. UPMC policy prohibits discrimination or harassment on the basis of race, color, religion, ancestry, national origin, age, sex, genetics, sexual orientation, marital status, familial status, disability, veteran status, or any other legally protected group status. Further, UPMC will continue to support and promote equal employment opportunity, human dignity, and racial, ethnic, and cultural diversity. This policy applies to admissions, employment, and access to and treatment in UPMC programs and activities. This commitment is made by UPMC in accordance with federal, state, and/or local laws and regulations.

Medical information made available on UPMC.com is not intended to be used as a substitute for professional medical advice, diagnosis, or treatment. You should not rely entirely on this information for your health care needs. Ask your own doctor or health care provider any specific medical questions that you have. Further, UPMC.com is not a tool to be used in the case of an emergency. If an emergency arises, you should seek appropriate emergency medical services.

For UPMC Mercy Patients: As a Catholic hospital, UPMC Mercy abides by the Ethical and Religious Directives for Catholic Health Care Services, as determined by the United States Conference of Catholic Bishops. As such, UPMC Mercy neither endorses nor provides medical practices and/or procedures that contradict the moral teachings of the Roman Catholic Church.

© UPMC
Pittsburgh, PA, USA UPMC.com