Abstract Details

Title Substance use-related cardiac arrest is associated with more withdrawal of life-sustaining therapies due to poor neurological prognosis

Topic Neuro Trauma, Critical Care, and Sports Neurology

Presentation(s) Neurocritical Care Posters (7:00 AM-5:00 PM)

Poster/Presentation
Number 017

Objective To determine clinical differences between non-substance use-related and substance use-related cardiac arrest (SURCA).

Background Substance-use is an emerging cause of cardiac arrest (CA) in the U.S., but there is limited knowledge about the clinical course and neurological prognostication characteristics.

Design/Methods Charts were retrospectively reviewed for adults who achieved sustained return of spontaneous circulation after CA and were admitted to an academic safety net hospital over a 13-month period. SURCA was defined as a positive toxicology screen on admission for opiates, stimulants, or benzodiazepines. Good outcome was defined as a Cerebral Performance Category score of 1-2 at discharge.

Results One-hundred and twenty-two subjects survived for at least six hours and underwent neurological prognostication, with 51 (41.8%) categorized as SURCA. Thirty-four subjects (27.9%) were alive at discharge and 18 (14.8%) had a good outcome. SURCA subjects were younger (48.8 vs. 67.6 years-old, p=.001), had lower rate of witnessed CA (52.9% vs. 78.9%, p=.002), and were more often homeless or marginally housed (35.3% vs. 9.9%, p=.001). They had more myoclonus (25.5% vs. 5.6%, p=.002) and lower Glasgow motor scores (5.9% vs. 18.3% flexor or better, p=.045) on admission. SURCA subjects underwent SSEP (13.7% vs. 2.8%, p=.023) and EEG (74.5% vs. 44.3%, p=.001) more frequently. There were no differences in good outcome, EEG characteristics, or rate of withdraw of life-sustaining therapies (WLST). Of the 78 subjects with WLST, 32 (41.0%) had SURCA. WLST due to poor neurological prognosis was more common among SURCA subjects (75.0% vs. 47.8%, p=.016) than WLST due to multi-organ failure or hemodynamic instability (12.5% vs. 34.8%, p=.027). No differences in time from CA to WLST, rate of WLST due to ethical reasons, or completion of in-person family meetings were observed.

Conclusions

SURCA may be associated with worse neurological injury contributing to a higher rate of WLST due to poor neurological prognosis than non-SURCA.

Authors/Disclosures
Jonathan Shih (University of California, San Francisco) PRESENTER	Jonathan Shih has nothing to disclose.
	No disclosure on file
	No disclosure on file
Jeffrey R. Vitt, MD (University of California, Davis)	Dr. Vitt has nothing to disclose.
	No disclosure on file
Claude Hemphill III, MD, FAAN (Zuckerberg San Francisco General Hospital)	Dr. Hemphill has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Zoll. Dr. Hemphill has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for various legal firms. The institution of Dr. Hemphill has received research support from NIH/NINDS.
Edilberto Amorim, MD	The institution of Dr. Amorim has received research support from American Heart Association. The institution of Dr. Amorim has received research support from Society of Critical Care Medicine. The institution of Dr. Amorim has received research support from Zoll Foundation. The institution of Dr. Amorim has received research support from Hellman Foundation. The institution of Dr. Amorim has received research support from Regents of the University of California. The institution of Dr. Amorim has received research support from Citizens United Against Epilepsy. The institution of Dr. Amorim has received research support from Regents of the University of California. The institution of Dr. Amorim has received research support from American Heart Association. The institution of Dr. Amorim has received research support from NIH. The institution of Dr. Amorim has received research support from Department of Defense.

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