Acute cardiac care & resuscitation
Delayed awakening after out-of-hospital cardiac arrest: a scoping review of definitions, determinants, and prognostic implications
- scoping review
Authors' conclusion
Delayed awakening after OHCA was predominantly influenced by treatment-associated variables and did not preclude meaningful neurological recovery. Nearly all existing evidence reflected outdated temperature management practices and was confounded by WLST-driven self-fulfilling prophecy bias, limiting conclusions regarding true outcomes. Standardised definitions and studies free of WLST-driven bias are urgently needed.
Study context
- Population
- Resuscitated adult out-of-hospital cardiac arrest (OHCA) patients with delayed awakeningpatients in nineteen studies (17 observational, 2 randomised trials, all high-income countries)
- Participants
- 5,441 participants
Main finding
As reported in the abstract
Proportion of patients with delayed awakening
11-52%
Further findings
Good neurological recovery among delayed awakeners · discharge
- Delayed awakeners achieving good neurological recovery across 4 cohorts
- 51-94%
- 51-94% achieved good neurological recovery at discharge across 4 cohorts
Study characteristics
- Studies predating International Liaison Committee on Resuscitation (ILCOR) recommendations
- Eighteen of 19
- Studies conducted in settings without withdrawal of life-sustaining therapy (WLST)
- two
Definitions of delayed awakening
- Distinct definitions
- Nine
- Time threshold
- 48 h-7 days
- reference point (post-resuscitation, post-rewarming, post-sedation withdrawal) and awakening criterion (Glasgow Coma Score, ability to follow commands, orientation, and Richmond Agitation-Sedation Scale) varied
Treatment-related determinants
- Therapeutic hypothermia, longer-acting sedatives, and prolonged sedation were the most consistent treatment-related determinants
Original publication
Summarised from the published abstract; every number is checked against it