What are the chances of good neurological recovery after in-hospital cardiac arrest (IHCA)?

From the Guidelines

The chances of good neurological recovery after in-hospital cardiac arrest (IHCA) are approximately 20-35%, with outcomes significantly influenced by factors such as time to CPR initiation, initial rhythm, age, comorbidities, and post-arrest care. Several factors can impact the likelihood of good neurological recovery, including:

• Time to CPR initiation: shorter times are associated with better outcomes 1
• Initial rhythm: shockable rhythms, such as ventricular fibrillation or ventricular tachycardia, have better outcomes than nonshockable rhythms 1
• Age: younger patients tend to have better outcomes than older patients 1
• Comorbidities: fewer comorbidities are associated with better outcomes 1
• Post-arrest care: targeted temperature management, maintaining adequate oxygenation, normocapnia, preventing seizures, and controlling blood glucose are all critical for neurological recovery 1 Targeted temperature management, which involves maintaining a constant temperature between 32 and 36°C for 24 hours, is a key component of post-arrest care and is recommended for adults after out-of-hospital cardiac arrest (OHCA) with an initial shockable rhythm who remain unresponsive after return of spontaneous circulation (ROSC) 1. Additionally, early coronary angiography should be considered for patients with suspected cardiac etiology, and neurological prognostication should be delayed until at least 72 hours after ROSC and after rewarming if temperature management was used 1. The combination of clinical examination, electrophysiological studies, biomarkers, and imaging provides the most accurate assessment of potential recovery, and a multidisciplinary approach to post-arrest care is essential for optimizing outcomes.

From the Research

Chances of Good Neurological Recovery after In-Hospital Cardiac Arrest (IHCA)

• The chances of good neurological recovery after IHCA can be improved with organized bundles of neurocritical care interventions, including prevention of secondary brain injury and identification of treatable causes of arrest 2.
• Targeted temperature management (TTM) with therapeutic hypothermia (TH) has been shown to improve neurological outcomes in patients after cardiac arrest, especially in those with an initial shockable rhythm 3.
• A study found that approximately 70% of IHCA survivors had a good functional neurological outcome, with return of spontaneous circulation without mechanical circulatory support and invasive coronary angiography and/or percutaneous intervention associated with a lower risk of 30-day in-hospital mortality 4.
• Extracorporeal cardiopulmonary resuscitation (ECPR) as adjunct to conventional cardiopulmonary resuscitation (CCPR) is a promising technique for IHCA treatment, with a large proportion of patients achieving good neurological outcome 5.
• Even in cases of prolonged resuscitation, a significant proportion of OHCA patients with refractory shockable rhythm can survive to a good neurologic outcome, with independent predictors including age, lower no-flow time, and lower serum lactate levels at hospital arrival 6.

Factors Influencing Neurological Recovery

• Initial electrocardiography (ECG) rhythm, with shockable rhythms associated with better neurological outcomes 3, 4.
• Time from cardiac arrest to return of spontaneous circulation (ROSC), with shorter times associated with better outcomes 4, 6.
• Presence of treatable acute causes of the arrest, such as acute coronary syndrome or pulmonary embolism 2, 4.
• Use of targeted temperature management (TTM) and therapeutic hypothermia (TH) 2, 3.
• Use of extracorporeal cardiopulmonary resuscitation (ECPR) as adjunct to conventional cardiopulmonary resuscitation (CCPR) 5.