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Time to Rethink Sepsis as a Contraindication to Post Cardiac Arrest Therapeutic Hypothermia? A Retrospective Analysis of Outcomes of PCATH With and Without Ensuing Sepsis FREE TO VIEW

Steven Huan-Ling Hsu, MD; Edwin Dominguez, MD; Ravindra Rajmane, MD
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New York Downtown Hospital, New York, NY

Chest. 2013;144(4_MeetingAbstracts):424A. doi:10.1378/chest.1704154
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SESSION TITLE: Sepsis and Shock Posters

SESSION TYPE: Original Investigation Poster

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

PURPOSE: Improved neurologic outcome has been demonstrated in post-cardiac arrest therapeutic hypothermia (PCATH) due to potential neuroprotective mechanisms. However, infectious complications in PCATH have been increased in out-of-hospital (OHCA) and inpatient cardiac arrest (CA) patients through impaired inflammatory response, increased insulin resistance, and hyperglycemia. Conversely, data are emerging that therapeutic hypothermia (TH) may be beneficial in severe infections in animal model. Our institution excludes patients with sepsis from PCATH. This study seeks to analyze the impact on mortality between patients with uncomplicated TH compared to those with TH who later developed sepsis.

METHODS: Our study is a retrospective chart review of patients with PCATH admitted to New York Downtown Hospital from July 2010 to March 2013. We looked at PCATH patients with and without ensuing sepsis and also at those with OHCA and inpatient CA.

RESULTS: We identified 22 PCATH patients. 27.3% had uncomplicated PCATH and 72.7% had PCATH which later progressed to sepsis. Survival to discharge or transfer was 83.3% for uncomplicated PCATH group (33.3% discharge, 50% transferred) and 12.5% for the PCATH and sepsis group (p=0.004). In subset analysis, 5 were OHCA and 17 were inpatient CA. Between the two groups: incidence of infection were 40% and 76% (p= 0.27), antibiotic use were 40% and 82% (p=0.10), survival to discharge or transfer were 40% and 29.4%, and mortality were 60% and 70%, respectively, which did not achieve statistical significance.

CONCLUSIONS: Our study shows increased survival to discharge or transfer, and reduction in mortality in uncomplicated versus complicated by sepsis PCATH patients. There is no statistical difference in incidence of infection, survival, or mortality between OHCA and inpatient CA patients. We postulate that sepsis that develops after PCATH increases overall mortality.

CLINICAL IMPLICATIONS: Although TH may have a role in protecting neurologic outcomes and potentially, mortality, in sepsis, our study shows worse outcomes for PCATH who develop subsequent sepsis. Further study is needed to evaluate outcomes in patients who present with concomitant sepsis and undergo PCATH.

DISCLOSURE: The following authors have nothing to disclose: Steven Huan-Ling Hsu, Edwin Dominguez, Ravindra Rajmane

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