What is full recovery? Reconsidering outcome of cardiopulmonary cerebral resuscitation beyond Glasgow–Pittsburgh Cerebral Performance Categories 1

Introduction

Cerebral performance of survivors from cardiopulmonary arrest is usually based on the Glasgow–Pittsburgh Cerebral performance categories (GP-CPC), and favorable neurological outcome are GP-CPC 1 (good cerebral performance) and GP-CPC 2 (moderate cerebral disability). Especially, CPC 1 is called full recovery. However, do the patients categorized as GP-CPC 1 work as they did before? We evaluated higher brain function among patients who were classed GP-CPC 1 and analyzed the factors influencing it.

Methods

A retrospective, observational, cohort study was conducted on consecutive patients (age ≥ 18 years) who were survivors from cardiopulmonary arrest hospitalized through the Emergency Department between 1 October 2006 and 31 March 2008 in an urban teaching hospital of Japan. There were 428 patients with cardiopulmonary arrest (CPA), and 136 patients (32%) were admitted to our hospital. Fifteen patients were categorized GP-CPC 1 and their higher brain functions were evaluated by physical therapists 1 month after CPA. Data were based on the Utstein style and collected on age, gender, location of cardiac arrest, witnessed, bystander cardiopulmonary resuscitation (CPR), defibrillator and cardioversion (DC) or automated external defibrillator (AED) use, return of spontaneous circulation prior to Emergency Department arrival, estimated time of cardiac arrest, cardiac cause, and therapeutic mild hypothermia.

Results

Among 15 eligible patients, eight cases with nonhigher brain dysfunction and seven cases with higher brain dysfunction were analyzed. In patients with nonhigher dysfunction: bystander CPR, eight cases (100%); witnessed, eight cases (100%); and DC (AED) use, eight cases (100%). In patients with higher brain dysfunction: bystander CPR, three cases (43%); witnessed, five cases (71%); and AED (DC) use, six cases (86%). Patients with nonhigher brain dysfunction were more likely to receive bystander CPR than those with higher brain dysfunction (Fisher's exact test P = 0.026).

Conclusion

One-half of patients who were generally called full recovery could not work as they did before because they had higher brain dysfunction after resuscitation. It is important to analyze factors that influence the recovery to higher brain function in patients with GP-CPC 1 to improve the outcome of cardiopulmonary cerebral resuscitation.