The benefits of inducing MTH in out-of-hospital cardiac arrest (OHCA) patients with ventricular fibrillation (VF)/ventricular tachycardia (VT) has been well established in multiple randomized controlled trials. Based on this data, the International Liaison Committee on Resuscitation has given MTH a Class IIB recommendation after in-hospital cardiac arrest (IHCA) irrespective of initial rhythm. Efficacy of MTH in such patients is unknown. We assessed neurological outcomes and survival in a population of IHCA patients treated with MTH.
Inclusion criteria were as follows: in-hospital location of arrest, survival to ICU transfer, return of spontaneous circulation (ROSC) less than 60 minutes, no response to verbal commands, pre-arrest independence in activities of daily living, and absence of terminal illness. MTH was induced using a combination of rapid iced saline infusion, ice water gastric lavage, and evaporative cooling using a high-speed fan. Patient temperature was maintained between 32–34°C for 24 hours followed by passive re-warming. Neurological function and survival was assessed by documented neurological exam on day of discharge. Outcomes were compared to a published database of 36,000 in-hospital arrest patients not treated with MTH.
Forty consecutive in-hospital post-arrest patients meeting inclusion criteria were treated with MTH from 4/2006 to 4/2009. Average age was 60. Initial rhythm was pulseless electrical activity (PEA) in 19, asystole in 16, VT/VF in 5. Sixteen of 40 patients (40%) recovered from cardiac arrest to a Pittsburg cerebral performance category (CPC) score of 1 or 2, of which 11 (27.5% of total) survived to hospital discharge. Five of 19 (26%) PEA patients, 3 of 16 (19%) asystole patients, and 3 of 5 (60%) VF patients were discharged from the hospital with good neurological recovery.
Outcomes of this study suggest possible benefit of MTH in post-IHCA patients admitted to the ICU when compared to historical published data. Further study is warranted.
MTH induction in selected IHCA survivors could lead to improved neurological outcomes and survival.
Joseph Mathew, No Financial Disclosure Information; No Product/Research Disclosure Information