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Coagulation measures after cardiac arrest (CMACA).

Hyo Joon Kim1, Kurz Michael2, Jung Hee Wee3

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Coagulation abnormalities like elevated prothrombin time (PT) and D-dimer after cardiac arrest are linked to poor neurological outcomes. Monitoring these factors is crucial for predicting patient recovery following targeted temperature management (TTM).

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Area of Science:

  • Cardiology
  • Hematology
  • Critical Care Medicine

Background:

  • Cardiac arrest (CA) and cardiopulmonary resuscitation (CPR) trigger blood coagulation activation and impaired fibrinolysis.
  • Understanding coagulation changes post-out-of-hospital CA (OHCA) is vital for patient outcomes.

Purpose of the Study:

  • To describe the temporal course of coagulation abnormalities after OHCA.
  • To investigate the association between coagulation changes and clinical outcomes in patients receiving targeted temperature management (TTM).

Main Methods:

  • Prospective, multicenter observational cohort study in 8 Korean emergency departments (Sept 2018-Sept 2019).
  • Analysis of laboratory coagulation findings at hospital admission and 24 hours post-return of spontaneous circulation (ROSC).
  • Primary outcome: Cerebral Performance Category (CPC) at discharge; Secondary outcome: in-hospital mortality.

Main Results:

  • Patients with poor neurological outcomes showed higher lactic acid, prothrombin time (PT), activated partial thrombin time (aPTT), international normalized ratio (INR), and D-dimer levels at admission and 24h post-ROSC.
  • Lactic acid and D-dimer decreased, while fibrinogen increased over time; PT, aPTT, and INR remained stable.
  • Admission PT and 24h post-ROSC D-dimer levels correlated with neurological outcomes at discharge.

Conclusions:

  • Coagulation factor changes post-OHCA are dynamic and varied.
  • Admission PT and 24h post-ROSC D-dimer levels are significant predictors of poor neurological outcomes in TTM-treated patients.