Cardiac arrest: Nimodipine may increase the chance of having neurological deficits.

The study

• <15 years old
• basic life support not started within 10 minutes of cardiac arrest
• advanced life support not started within 20 minutes of cardiac arrest, and spontaneous circulation not restored within 30 minutes.
• unwitnessed cardiac arrests if ventricular fibrillation was not coarse (<1 millivolt)
• study treatment not given at 30 minutes after cardiac arrest
• probable extra-cardiac causes of ventricular fibrillation (eg. trauma, exsanguination, suspected intracranial haemorrhage)
• pregnancy
• previous severe brain damage
• chronic disorder causing loss of independence in activities of daily living
• response to verbal commands immediately after resuscitation


Control Group: (n = 33, 33 analysed): Placebo
Experimental Group: (n = 35, 35 analysed): Nimodipine-10 micrograms per kilogram body weight intravenously after restoration of spontaneous circulation, followed by infusion of 0.5 micrograms per kilogram body weight per minute for 24 hours

100% followed for 12 months Neurological deficits
Outcome notes:
• no neurological deficits : at 3 months. Determined by using Wechsler adult intelligence scale, verbal intelligence quotient, performance intelligence quotient, parts of Wechsler memory scale, memory quotient-mean 100; standard deviation 15, delayed retrieval of logical stories, associative learning- mean 85; standard deviation 7, verbal skills, motivation during tests (1, normal to 5, severe disturbances), Center for Epidemiological Studies Depression Scale (0 to 60). Scores =2 standard deviations below normal population considered moderate to severe disturbances.
• 1 or 2 neurological deficits : at 3 months
• more than 2 neurological deficits : at 3 months
• no neurological deficits : at 12 months
• 1 or 2 neurological deficits : at 12 months
• more than 2 neurological deficits : at 12 months

The evidence

Outcome	Time to outcome	CER	EER	RRR (95% CI)	ARR (95% CI)	NNH (95% CI)
no neurological deficits	3 months	16 (48.5%)	11 (31.4%)	35.0% (-18.0% to 65.0%)	17.1% (-6% to 40%)	6 (NNT = 17 to infinity; NNH = 2 to infinity)
1 or 2 neurological deficits	3 months	9 (27.3%)	14 (40.0%)	-47.0% (-192% to 26%)	-12.7% (-35.0% to 9.51%)	8 (NNT = 3 to infinity; NNH = 11 to infinity)
more than 2 neurological deficits	3 months	8 (24.2%)	10 (28.6%)	-18.0% (-162% to 47%)	-4.33% (-25.3% to 16.6%)	23 (NNT = 4 to infinity; NNH = 6 to infinity)
no neurological deficits	12 months	15 (45.5%)	13 (37.1%)	-18.0% (-54% to 45%)	-8.31% (-31.7% to 15.0%)	12 (NNT = 7 to infinity; NNH = 3 to infinity)
1 or 2 neurological deficits	12 months	8 (24.2%)	10 (28.6%)	-18.0% (-162% to 47.0%)	-4.33% (-25.3% to 16.6%)	23 (NNT = 4 to infinity; NNH = 6 to infinity)
more than 2 neurological deficits	12 months	2 (6.06%)	6 (17.1%)	-183% (-1204% to 39.0%)	-11.1% (-26.0% to 3.82%)	9 (NNT = 4 to infinity; NNH = 26 to infinity)




Comments

1. The trial is too small to show a clear effect with nimodipine.



Citation

1. Roine RO, Kajaste S, Kaste M: Neuropsychological Sequelae of Cardiac Arrest. JAMA 1993; 269: 237-242
Contributor: Clare Wotton & Chris Ball, October 1999
Reviewer: William Rhoton

_{Clinical Question.}

Patient	cardiac arrest
Intervention or Exposure	nimodipine
Outcome	neurological deficit