PURPOSE: Multiple, controlled studies have demonstrated the neurological benefits of mild therapeutic hypothermia (MTH) in out-of-hospital cardiac arrest (OHCA) survivors, with similar complication rates observed between groups. The safety of MTH after in-hospital cardiac arrest (IHCA) is unknown and may be less well tolerated given the multiple co-morbidities present in this patient population. We assessed the rates of adverse events in a population of IHCA patients treated with MTH, compared to historical controls.
METHODS: We performed a retrospective chart review of all 7494 patients admitted to our medical intensive care unit from 2003-2009 and identified 118 patients admitted after IHCA. Two blinded investigators reviewed these 118 charts to identify the patients meeting inclusion criteria of our institution’s IHCA-MTH protocol. 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. MTH was induced via a combination of cold saline infusion, ice water gastric lavage, and fanning. Occurrences of bleeding requiring transfusion, pneumonia, sepsis, acute renal failure, need for hemodialysis, pulmonary edema, or arrhythmia requiring intervention were collected and compared between groups.
RESULTS: 30 patients meeting criteria for MTH therapy were identified and included in the analysis, with half admitted before the MTH protocol in 2006 and half after (MTH group, n=15, Control group, n=15). All patients in the MTH group received MTH therapy. Average age in MTH and controls were 59 and 65 respectively (p< .05). 60% of MTH vs. 53% of controls suffered at least one adverse event (p=0.71). 27% of MTH vs. 40% of controls suffered > 1 adverse event (p=0.69).
CONCLUSION: Although limited by small sample size, no increase in adverse events was observed in a population of IHCA patients treated with MTH when compared to a group of historical control patients.
CLINICAL IMPLICATIONS: Inducing MTH is safe in patients resuscitated from IHCA.
DISCLOSURE: Jaspreet Ahuja, No Financial Disclosure Information; No Product/Research Disclosure Information