PURPOSE: Current guidelines suggest a possible benefit of MTH after IHCA despite lack of controlled studies of MTH in this patient population. We compared the neurological outcomes of IHCA patients treated with MTH to historical controls at our institution.
METHODS: We performed a retrospective chart review of all patients (n=7494) admitted to our MICU from 2003-2009 and identified 118 patients who were admitted after IHCA. Two blinded investigators reviewed these 118 charts to identify patients meeting inclusion criteria of our institution’ s IHCA-MTH protocol. Inclusion criteria for MTH after IHCA were: no response to verbal commands, arrest location in Emergency Department or medical wards, arrest duration <45 minutes, pre-morbid independence in activities of daily living, absence of terminal illness or do-not-resuscitate order, hemodynamic stability, and absence of uncontrolled bleeding. Patients admitted after introduction of the MTH protocol in 2006 made up the MTH group. Patients admitted prior to 2006 made up the control group. The primary outcome was survival to discharge with good neurological function, measured by Cerebral Performance Category (CPC) score. Chi-square test was used for comparison between groups.
RESULTS: 30 patients admitted to the MICU after IHCA met inclusion criteria for analysis (MTH group, n=15, Control group, n=15). All patients in the MTH group received MTH therapy. 27/30 patients had an arrest rhythm of asystole or pulseless electrical activity (PEA). 5 patients (33%) in each group survived to discharge with good neurological function. A greater number of patients in the MTH group achieved a CPC score of 1 or 2 after their arrest, though this difference was not statistically significant (7/15 vs. 5/15, p=0.47) and did not lead to improved outcome at discharge.
CONCLUSION: Although limited by small sample size, no benefit in neurological outcome was observed in a population of selected IHCA patients treated with MTH when compared to historical controls.
CLINICAL IMPLICATIONS: MTH does not improve neurologic outcome after IHCA in a population that consists largely of asystole and PEA arrests.
DISCLOSURE: Mayuko Fukunaga, No Financial Disclosure Information; No Product/Research Disclosure Information