Induced hypothermia improves outcome after cardiac arrest due to ventricular fibrillation. We studied induced hypothermia in a community hospital setting after cardiac arrest due to any cause.
A case-control study was conducted in a publicly owned, non-academic, acute care hospital. Thirty-eight patients who underwent induced hypothermia were compared to 103 patients who did not undergo hypothermia. After resuscitation from cardiac arrest, patients underwent hypothermia using an established protocol at the discretion of the treating clinicians. Hypothermia was achieved with either external devices or an intravascular cooling catheter system. Outcome measures included mortality, neurologic recovery, and length of stay (LOS).
The groups were similar in age, sex, APACHE III score, and Glasgow Coma Score (GCS). Hospital mortality in the hypothermia group was 53% versus 71% in the control group (p=0.07). Hospital mortality in 10 patients treated with intravascular cooling was 40%. Compared to Apache III predicted mortality, the hypothermia group mortality ratio was 0.76, versus 1.4 for the control group. Among survivors, the change in GCS from admission to ICU discharge was 7.2 +/- 4.0 (baseline 4.4, discharge 11.7) in the hypothermia group and 6.6 +/- 4.3 (baseline 4.0, discharge 10.6) in the control group (p=0.32). Also among survivors, the ICU LOS was 2.6 +/- 3.5 days less than Apache III predicted in the hypothermia group versus 0.5 +/- 6.8 days less in the control group (p=0.08).
Induced hypothermia following cardiac arrest performs well in a community hospital setting. The intravascular cooling catheter was a safe, effective means of inducing hypothermia with a trend towards improved outcomes. Induced hypothermia may be applicable to all cardiac arrest patients regardless of cause.
Induced hypothermia is safe, simple, and inexpensive. Hospital protocols may help to ensure timely application of this important intervention. Intravascular cooling techniques show promise in terms of ease of use, effectiveness of cooling, and maintaining accessibility to the patient. Further study is needed to determine the optimal patients and techniques for therapeutic hypothermia.
Kenneth Hurwitz, None.