ArticleIntensive care medicine2016
Delayed awakening after cardiac arrest: prevalence and risk factors in the Parisian registry.
Article in Intensive care medicine, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 59 papers, 6 of them syntheses that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
59 citing papers in PubMed, 6 syntheses or guidelines pooled it, 142 citations in OpenAlex.
- European Resuscitation Council and European Society of Intensive Care Medicine guidelines 2025: post-resuscitation care.Intensive care medicine · 2025Guideline
- Pharmacokinetics of Opioid Infusions in the Adult Intensive Care Unit Setting-A Systematic Review.Clinical pharmacokinetics · 2025Pooled it
- Comparison of prognosis between extracorporeal CPR and conventional CPR for patients in cardiac arrest: a systematic review and meta-analysis.BMC emergency medicine · 2024Pooled it
- Guidelines for Neuroprognostication in Comatose Adult Survivors of Cardiac Arrest.Neurocritical care · 2023Guideline
- Extracorporeal life support during cardiac arrest and cardiogenic shock: a systematic review and meta-analysis.Intensive care medicine · 2016Pooled it
- The rate of brain death and organ donation in patients resuscitated from cardiac arrest: a systematic review and meta-analysis.Intensive care medicine · 2016Pooled it
- A multicentre randomized pilot trial on the effectiveness of different levels of cooling in comatose survivors of out-of-hospital cardiac arrest: the FROST-I trial.Intensive care medicine · 2018Trial
- EAST Multicenter Trial on targeted temperature management for hanging-induced cardiac arrest.The journal of trauma and acute care surgery · 2018Trial
- Neurological prognostication after cardiac arrest: evidence review and institutional protocol proposal.Arquivos de neuro-psiquiatria · 2026Review
- Distinct Trajectories of Consciousness Recovery During Targeted Temperature Management in Out-of-Hospital Cardiac Arrest Survivors: A Cluster Analysis.Medicina (Kaunas, Lithuania) · 2026Article
- Differentiating Late Awakeners from Non-Awakeners in Comatose Cardiac Arrest Survivors: Diagnostic Value of Multimodal Monitoring in Patients with Indeterminate Prognosis.Diagnostics (Basel, Switzerland) · 2026Article
- Connectome disruptions after hypoxic-ischaemic injury associate with consciousness disorder severity.Brain communications · 2026Article
- Withdrawal of life-sustaining therapies after cardiac arrest.Current opinion in critical care · 2025Review
- Rib fractures after chest compressions for cardiac arrest: retrospective analysis of the AfterROSC1 and AfterROSC2 multicenter databases.Resuscitation plus · 2025Article
- System for Predicting Neurological Outcomes Following Cardiac Arrest Based on Clinical Predictors Using a Machine Learning Method: The Neurological Outcomes After Cardiac Arrest Method.Neurocritical care · 2025Article
- Altered lower brainstem neurophysiological response is associated with mortality in deeply sedated critically ill patients.Intensive care medicine · 2025Observational
- Construction and validation of prognostic model for ICU mortality in cardiac arrest patients: an interpretable machine learning modeling approach.European journal of medical research · 2025Article
- Multimodal assessment of favorable neurological outcome using NSE levels and kinetics, EEG and SSEP in comatose patients after cardiac arrest.Critical care (London, England) · 2025Article
- Personalized neuron-specific enolase level based on EEG pattern for prediction of poor outcome after cardiac arrest.Annals of intensive care · 2025Article
- Impact of coma duration on functional outcomes at discharge and long-term survival after cardiac arrest.Resuscitation · 2025Article
Corrections and comments
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Authors and funding
10 authors at 6 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeAlthough prolonged unconsciousness after cardiac arrest (CA) is a sign of poor neurological outcome, limited evidence shows that a late recovery may occur in a minority of patients. We investigated the prevalence and the predictive factors of delayed awakening in comatose CA survivors treated with targeted temperature management (TTM).
methodsRetrospective analysis of the Parisian Region Out-of-Hospital CA Registry (2008-2013). In adult comatose CA survivors treated with TTM, sedated with midazolam and fentanyl, time to awakening was measured starting from discontinuation of sedation at the end of rewarming. Awakening was defined as delayed when it occurred after more than 48 h.
resultsA total of 326 patients (71 % male, mean age 59 ± 16 years) were included, among whom 194 awoke. Delayed awakening occurred in 56/194 (29 %) patients, at a median time of 93 h (IQR 70-117) from discontinuation of sedation. In 5/56 (9 %) late awakeners, pupillary reflex and motor response were both absent 48 h after sedation discontinuation. In multivariate analysis, age over 59 years (OR 2.1, 95 % CI 1.0-4.3), post-resuscitation shock (OR 2.6 [1.3-5.2]), and renal insufficiency at admission (OR 3.1 [1.4-6.8]) were associated with significantly higher rates of delayed awakening.
conclusionsDelayed awakening is common among patients recovering from coma after CA. Renal insufficiency, older age, and post-resuscitation shock were independent predictors of delayed awakening. Presence of unfavorable neurological signs at 48 h after rewarming from TTM and discontinuation of sedation did not rule out recovery of consciousness in late awakeners.
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