Journal
RESUSCITATION
Volume 84, Issue 6, Pages 818-824Publisher
ELSEVIER IRELAND LTD
DOI: 10.1016/j.resuscitation.2012.11.014
Keywords
Cardiac arrest; Resuscitation; Coma; Methylphenidate; Amantadine
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Funding
- National Heart, Lung, and Blood Institute [2 U01 HL07787-07]
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Background: Despite critical-care packages including therapeutic hypothermia (TH), neurologic injury is common after cardiac arrest (CA) resuscitation. Methylphenidate and amantadine have treated coma in traumatically-brain-injured patients with mixed success, but have not been explored in post-arrest patients. Objective: Compare the outcome of comatose post-arrest patients treated with neurostimulants to a matched cohort. Methods: Retrospective cohort study from 6/2008 to 12/2011 in a tertiary university hospital. We included adult patients treated with methylphenidate or amantadine after resuscitation from in-hospital or out-of-hospital CA (OHCA) of any rhythm, excluding patients with traumatic/surgical etiology of arrest, terminal re-arrest within 6 h, or withdrawal of care by family within 6 h. Primary outcome was following commands; secondary outcomes included survival to hospital discharge, cerebral performance category (CPC), and modified Rankin scale (mRS). We compared characteristics and outcomes to a control cohort matched on TH and 72 h FOUR score +/- 1. Results: Of 588 patients, 8 received methylphenidate, 6 received amantadine, and 2 both. Most were female suffering OHCA with median age 61 years. All received TH and a multi-modal neurological evaluation. Initial exam revealed median GCS 6 and FOUR 7, which was unchanged at 72 h. Six patients (38%) followed commands prior to discharge at median 2.5 days (range: 1-18 days) after treatment. Patients receiving neurostimulants trended toward improved rate of following commands, survival to hospital discharge, and distribution of CPC and mRS scores. Conclusions: Neurostimulants may be considered to stimulate wakefulness in selected post-cardiac arrest patients, but a prospective trial is needed to evaluate this therapy. (C) 2012 Elsevier Ireland Ltd. All rights reserved.
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