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Abstract: Slide Presentations |

OUTCOMES OF MILD THERAPEUTIC HYPOTHERMIA (MTH) IN IN-HOSPITAL CARDIAC ARREST PATIENTS FREE TO VIEW

Joseph P. Mathew, MD*; Pierre Kory, MD; Mayuko Fukunaga, MD; Crescens Pellecchia, DO; Justin Weiner, DO; Paul H. Mayo, MD
Author and Funding Information

Beth Israel Medical Center, New York, NY


Chest


Chest. 2009;136(4_MeetingAbstracts):29S. doi:10.1378/chest.136.4_MeetingAbstracts.29S-h
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Abstract

PURPOSE:  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.

METHODS:  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.

RESULTS:  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.

CONCLUSION:  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.

CLINICAL IMPLICATIONS:  MTH induction in selected IHCA survivors could lead to improved neurological outcomes and survival.

DISCLOSURE:  Joseph Mathew, No Financial Disclosure Information; No Product/Research Disclosure Information

Tuesday, November 3, 2009

10:30 AM - 12:00 PM


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