Critical Care |

Early Vs Late Initiation of Induced Hypothermia: Is There Any Benefit? FREE TO VIEW

Said Chaaban, MD; K James Kallail, PhD; Colin Parry, MA; Dawn Gosnell, MSN; Melissa Donaldson, RN; Darrell Youngman, DO
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University of Kansas School of Medicine-Wichita, Wichita, KS

Chest. 2013;144(4_MeetingAbstracts):360A. doi:10.1378/chest.1702869
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SESSION TITLE: Critical Care Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: Therapeutic hypothermia (TH) is associated with survival and neurological benefits in patients with Return of Spontaneous Circulation (ROSC) but without meaningful neurologic activity after out-of-hospital cardiac arrest. Guidelines suggest that TH should be initiated within six hours from ROSC, but the best timing is unknown. We evaluated whether there were differences in the outcomes of TH started early or late after arrest.

METHODS: The medical records of patients at one medical center who received TH since 2010 were reviewed. Patients receiving TH within the first two hours after cardiac arrest (early group) were compared to those receiving TH after two hours (late group).

RESULTS: Fourteen patients in the early group and thirty-five patients in the late group were evaluated. Male patients were most likely to be in the early group (p=0.02). There were no statistical differences in age, BMI, initial heart rhythm, underlying coronary artery disease, arrhythmia, ST elevation post ROSC, and number receiving heart catheterization. The early group had cold saline introduced in the ED more often whereas the late group received TH in the Coronary Intensive Care Unit (CICU; p=0.0001). The mean number of hours to target temperature was similar (p=0.88), but the mean lowest cooling temperature was lower in the early group (31.97oC vs 32.45oC; p=0.04). Cooling methods, whether internal or external, were similar (p=0.20). No difference was shown in mortality (p=0.30). Neurological outcome was similar in both groups as scored by the Cerebral Performance Category scale (p=0.63). Decreased length of stay in the CICU (6.4 vs 9.9 days; p=0.038) and overall hospital stay (7.7 vs 14.0 days; p=0.079) were noted in the early group. No differences were noted in aftercare placement (p=0.66).

CONCLUSIONS: Initiation of therapeutic hypothermia within two hours of cardiac arrest showed no differences in patient outcomes when compared to late initiation but had a decreased length of CICU and overall hospital stay.

CLINICAL IMPLICATIONS: Neurologic recovery and survival improvement can be obtained in patients who undergo either early or late TH initiation.

DISCLOSURE: The following authors have nothing to disclose: Said Chaaban, K James Kallail, Colin Parry, Dawn Gosnell, Melissa Donaldson, Darrell Youngman

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