Although the survival and neuroprotective benefits of MTH in out-of-hospital cardiac arrest (OHCA) from ventricular fibrillation (VF) have been well established, controversy exists regarding the utility of MTH after in-hospital cardiac arrest (IHCA) despite the International Liason Committee on Resuscitation (ILCOR) Grade IIB recommendation. Concerns regarding both safety and efficacy have been raised given the often multiple co-morbidities present among in-hospital patients. We compared the complication rates of MTH after IHCA at our institution to the OHCA data reported in the Hypothermia After Cardiac Arrest (HACA) trial.
A retrospective chart review of all IHCA patients treated with MTH at our institution was performed. Data on the following clinically significant events over the 72 hours following induction of MTH were collected: bleeding requiring transfusion, pneumonia, sepsis, acute renal failure, need for hemodialysis, pulmonary edema, or arrhythmia requiring intervention. Data from these IHCA patients were then compared to the OHCA date from the HACA trial using chi-square analysis with Fisher's exact test.
A total of 32 IHCA patients received MTH. Average age was 60. Initial rhythm was pulseless electrical activity in 17, asystole in 16, and VF in 5. 76% (29/38) of patients had a complication compared to 70% reported in the IHCA group (p = .84). Bleeding (15% (6/38) vs. 26% (35/135), p = .28), pneumonia (23% (9/38) vs. 37% (50/135), p = .17), and sepsis (15% (6/38) vs. 13% (17/135), p = .59) were similar between groups. Pulmonary edema (30% (12/38) vs. 7% (9/136), p < .01) and acute renal failure (20% (8/32) vs. 10% (13/135), p = .03) occurred significantly more among IHCA patients, without an increased need for hemodialysis (0% (0/32) vs. 4% (6/135), p = .34).
Inducing MTH after IHCA has similar complication rates to those reported in the HACA trial. MTH appears safe to induce among IHCA patients with multiple co-morbidities.
Given safety of MTH after IHCA, further study to determine efficacy should be conducted.
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