**Author details**

Rahul Nanchal and Gagan Kumar

*Division of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee, WI, USA* 

### **5. References**


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**Section 6** 

**Therapeutic Hypothermia-**

**Neuroprognostication/Drug Metabolism** 


**Therapeutic Hypothermia-Neuroprognostication/Drug Metabolism** 

110 Therapeutic Hypothermia in Brain Injury

S26 (Abstract).

Transplantation 2003; 75, 2034–2039.

1168

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**Chapter 8** 

© 2013 Palagiri et al., licensee InTech. This is an open access chapter distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

© 2013 Palagiri et al., licensee InTech. This is a paper distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

**Prognostication in Post Cardiac Arrest Patients** 

There are over 300,000 out-of-hospital cardiac arrests (OHCA), and 200,000 in-hospital cardiac arrests (IHCA), annually in the U.S. alone. Of these, the survival rate is only 6.4% and 17% respectively (1). Sasson et al. reviewed 75 studies of OHCA, including over 140,000 patients, and found that the pooled survival rate to hospital admission was only 24%, and pooled survival to hospital discharge was only 7.6% (2). Also noted, via the Get With The Guidelines Registry (GWTG-R), was that the rate of survival to hospital discharge after IHCA was 18% for ventricular fibrillation and pulseless ventricular tachycardia, 12% for pulseless electrical activity (PEA), and 13% for asystole (2). During and post cardiac arrest, patients undergo profound systemic ischemia followed by reperfusion. This leads to what is now known as post cardiac arrest syndrome (PCAS), which is comprised of four entities: brain injury, myocardial dysfunction, ischemic/reperfusion response, and the precipitating disease (3). As many as 30% of cardiac arrest survivors will suffer from permanent brain injury (4). The percentage of survivors from the initial cardiac arrest, that subsequently die, is fairly comparable around the world, around 65-75%. Most of these patients die within the first month after return of spontaneous circulation (ROSC). Although the components leading up to survival from cardiac arrest are very important (early access, early CPR, early defibrillation and early advanced care), the main entity that limits ultimate recovery is brain injury from hypoxia. This chapter is mainly concerned with the post cardiac arrest brain injury that occurs and how to prognosticate its recovery. The only treatment that has been proven to improve mortality and neurological outcome is therapeutic hypothermia (TH). Before the utilization of therapeutic hypothermia, many of these post cardiac arrest survivors succumbed to anoxic brain damage (5). As therapeutic hypothermia continues to become standard practice across the world for post cardiac arrest patients, the new question that arises is when and how best to prognosticate both the survivors and non-surviovors of therapeutic hypothermia.Multiple studies have shown that prognostication within 24-48 hrs

**Treated with Therapeutic Hypothermia** 

Ashok Palagiri, Farid Sadaka and Rekha Lakshmanan

Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/55496

**1. Introduction** 
