SESSION TITLE: Therapeutic Hypothermia
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Monday, October 28, 2013 at 07:30 AM - 09:00 AM
PURPOSE: Therapeutic hypothermia (TH) improves neurologic outcomes in patients successfully resuscitated after an out of hospital cardiac arrest, more often if ventricular arrhythmia was the first detectable rhythm. Our aim was to monitor our outcomes and compare them with published literature.
METHODS: Our TH protocol was started in 2009, in accordance with published literature. IRB approval was obtained, prospective and retrospective data was collected. Those who underwent at least 12 hours of TH were included. Survival at discharge and neurological outcomes were looked at. The neuro-outcome was chosen as a cerebral performance category (CPC) score. CPC of 1 and 2 was considered “Good”. Subsequently a case-control analysis of inpatients was done. SPSS was used.
RESULTS: 39 patients underwent TH, 36 were included for analysis. 22 inpatients and 14 outpatients. The mean time from arrest to successful resuscitation was 15.2 minutes. The mean time from resuscitation to goal temperature was about 6 hours. 57 % of the outpatients had good neuro-outcome, almost similar as Bernard’s study's 55% (Bernard etal,NEJM 2002), in which only outpatient vfib arrests were included. Our patients with “shockable rhythm” were 3 times more likely to have “good neuro-outcome” (p =0.01). Survival at discharge was similar between outpatients and inpatients, 64.3% and 63.6% respectively (p=0.96). Among survivors, outpatients were 2.4 times more likely to have good neuro-outcomes than inpatients (p= 0.02). As inpatients had poor neuro-outcomes, to look for benefit of TH in “inpatient arrests”, 12 “highly select cooled inpatients”, defined as “coolable by all criteria in retrospect” were compared to 7 coolable pre- TH era controls. The good neuro-outcomes were similar in both groups; 50% and 43% respectively (p=0. 76), as was survival, despite our controls being sicker with higher mean SAPS2 (p=0.3) and higher mean length of stay (p= 0.002) than cases.
CONCLUSIONS: At our institute TH has shown similar favorable neuro-outcomes in outpatients, as published literature, however this benefit did not extend to inpatients.
CLINICAL IMPLICATIONS: Studies will be needed to evaluate TH in “inpatient arrests”.
DISCLOSURE: The following authors have nothing to disclose: Abhishek Vedavalli, Renaud Gueret, Aiman Tulaimat, John Bailitz, Gurpreet Singh, Kenneth Will, MIcheal Nelson
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