Neurological Outcomes After In-Hospital Cardiac Arrest

Study Overview
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Brief Summary
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Little is known about the long-term neurological outcomes after in-hospital cardiac arrest (IHCA). It is also not known whether withdrawal of life-sustaining measures will influence rates of survivors with poor neurological status. Currently, withdrawal of care in comatose patients after cardiac arrest is strongly forbidden by law in Korea. However, a new legislation on allowing withdrawal of care will come into effect since early 2018 in Korea. The investigators aim to determine 1) long-term neurological outcomes in patients who developed IHCA, 2) whether early neurological status can predict late neurological status after IHCA, and 3) whether the proportion of IHCA survivors with good neurological outcomes will change since implementation of new legislation on withdrawal of care.

Detailed Description
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<The schedule of assessment> Day 0: Neurological examination (First examination will be performed within 2 hours after IHCA) Day1 - 7: Neurological examination Day7, 14, 21, 28: Neurological examination, CPC score Day90: CPC score, survival Day180: CPC score, survival Day 360: CPC score, survival <Cerebral Performance Category(CPC) score> CPC 1: good cerebral performance CPC 2: Moderate cerebral disability(available for independent activities) CPC 3: Severe cerebral disability(dependent on others for daily support) CPC 4: Coma or vegetative state CPC 5: Brain death or death <Acronyms> ACDU(Alert/Confused/Drowsy/Unresponsive) score FOUR(Full Outline of Unresponsiveness) score

Official Title
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Neurological Outcomes After In-hospital Cardiac Arrest: a Prospective Observational Study

Conditions
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Inhospital Cardiac Arrest

Intervention / Treatment
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* Other: No intervention


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age ≥ 18 In-hospital cardiac arrest Cardiopulmonary Resuscitation(CPR) code activation and/or neurology consultation for IHCA Exclusion Criteria: Neither (CPR) code activation nor neurology consultation Development of IHCA during transition period

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Before Period<br>Patients who developed in-hosptial cardiac arrest before the implementation of new legislation on life-sustaining treatments | |
| After Period<br>Patients who developed in-hosptial cardiac arrest after the implementation of new legislation on life-sustaining treatments | Other: No intervention<br>* No intervention will be needed.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Cerebral Performance Category(CPC) score of 1-2 | CPC score is the most universal index to assess neurological outcome following cardiac arrest. CPC score is classified according to the point. Good neurological outcome is defined as CPC 1-2 and poor is CPC 3-5. CPC score will be evaluated by neurological examination and the results of other exam. Neurological examination: Neurologist will perform directly until the point of CPC score 1 is confirmed. mental status: ACDU score, FOUR score and Glasgow Coma Scale brain stem reflex: Light reflexes by pupillometer(the NeurOptics® NPi™-100 (Neuroptics Inc., Irvine, CA, USA)) and corneal reflexes motor status Responsive state: Medical Research Council grade Unresponsive state: motor response to painful stimuli) seizure evaluation: status myoclonus , seizure, status epilepticus The result of other examinations in accordance with medical treatment guideline will be evaluated as well. (e.g. Finding MRI of the brain, EEG, neuron specific enolase) | 12 month after In-Hospital Cardiac Arrest(IHCA) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| CPC score | CPC score is the most universal index to assess neurological outcome following cardiac arrest. CPC score is classified according to the point. Good neurological outcome is defined as CPC 1-2 and poor is CPC 3-5. CPC score will be evaluated by neurological examination and the results of other exam. Neurological examination: Neurologist will perform directly until the point of CPC score 1 is confirmed. mental status: ACDU score, FOUR score and Glasgow Coma Scale brain stem reflex: Light reflexes by pupillometer(the NeurOptics® NPi™-100 (Neuroptics Inc., Irvine, CA, USA)) and corneal reflexes motor status Responsive state: Medical Research Council grade Unresponsive state: motor response to painful stimuli) seizure evaluation: status myoclonus , seizure, status epilepticus The result of other examinations in accordance with medical treatment guideline will be evaluated as well. (e.g. Finding MRI of the brain, EEG, neuron specific enolase) | Day 7, day 14, day 21, day 28, 3 month, 6 month, and 12 month after IHCA | 
| Mortality | A measure of the number of deaths in a particular population | Day 0-28, 3 month, 6 month, and 12 month after IHCA | 
| Awakening | Following commands | Day 0-28 after IHCA | 
| Neurological recovery | CPC of 1 | Day 0-28 after IHCA | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Cardiac arrest, Inhospital Cardiac Arrest, Cardiopulmonary Resuscitation