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Retrospective Study of Performance, Complications, Outcomes of Hypothermia Protocol in a Large Community Hospital in Last Three Years FREE TO VIEW

Leena Gupta*, MD; Narinder Gill, MD; Ben Siu-James, MD
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Regional Medical Center of San Jose, San Jose, CA

Chest. 2012;142(4_MeetingAbstracts):386A. doi:10.1378/chest.1389002
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SESSION TYPE: Invasive Procedures and Hemodynamic Monitoring Posters

PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM

PURPOSE: (Abbreviations: OHHCA - for Out of Hospital cardiac arrest; HP - Hypothermia Protocol; PEA - pulseless electrical activity )Therapeutic hypothermia is widely accepted as a standard of practice for Out of Hospital cardiac arrest (OHHCA). However, its implementation is still highly variable in different hospital settings. Most of the current data comes from centers of excellence. We wanted to evaluate performance of implementation of “Hypothermia Protocol” (HP) including its complications and outcomes in our large referral community based hospital.

METHODS: We conducted retrospective chart review of 30 patients who underwent HP from 2008-2011. Data collected included demographics, time of cardiac arrest, time of arrival to ER and time to induction of HP, methods used for induction, complications and outcomes.

RESULTS: Out of the 30 patients, 16 patients (53%) had pulse less electrical activity (PEA), 13 (43.3%) patients had ventricular tachycardia/fibrillation, and 1 (3.33%) had complete heart block as the initial rhythm. Average time to arrive to ER was 30 minutes. Almost 60% of patients had HT induction in ED, 35% (%) in ICU and 6.66% paramedics outside of the hospital. Average time to initiate HT from the initial event was 1hour and 56 minutes. Average time to achieve the target temperature from the initial event was 2 hours. Inner cool (endovascular cooling system)was the most common modality used in 46.6 (%). Lactic acidosis (19.7%) was the most common complication encountered, followed by Hypotension (12%), Coagulopathy (12%) and Seizure (12%) Trend of improved outcomes with less renal failure, coagulopathy, seizure was observed with shorter induction times. Time to achieve target temperature had no effect. Initial rhythm, age and gender also had no impact on the outcome.

CONCLUSIONS: Shorter induction time appears to decrease complications and improve outcomes. Using multiple cooling modalities also appeared to have better outcomes. However larger studies are needed to confirm this observation.

CLINICAL IMPLICATIONS: Earlier induction of Therapeutic hypothermia improves survival and neurological outcome as well as appears to decrease incidence of some of the complications.

DISCLOSURE: The following authors have nothing to disclose: Leena Gupta, Narinder Gill, Ben Siu-James

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Regional Medical Center of San Jose, San Jose, CA




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