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Critical Care |

Outcomes of Mild Therapeutic Hypothermia After In-Hospital Cardiac Arrest: A Systematic Review of the Literature

Christina Lee, MD; Heather Siedenburg, DO; Daniel Fein, MD; Shamsher Mann; Pierre Kory, MD
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Beth Israel Medical Center, New York, NY


Chest. 2013;144(4_MeetingAbstracts):429A. doi:10.1378/chest.1704673
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Abstract

SESSION TITLE: Therapeutic Hypothermia

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Monday, October 28, 2013 at 07:30 AM - 09:00 AM

PURPOSE: Mild therapeutic hypothermia (MTH) has been shown in randomized, controlled trials (RCT) to improve neurological outcomes in patients who suffer out-of-hospital cardiac arrest (OHCA) from shockable rhythms. The utility of MTH after in-hospital cardiac arrest (IHCA) has not been as well studied. We performed a systematic review of the literature to identify all studies examining the utility of MTH after IHCA.

METHODS: We searched the Cochrane Central Register of Controlled trials, PubMed, EMBASE and BIOSIS through February 2012 to identify studies using MTH after IHCA. Randomized and non-randomized studies comparing survival or neurological outcome between MTH and standard care were selected. Case studies, abstracts, reviews, studies with less than 10 IHCA patients or an appropriate control group were excluded. We corresponded with authors to clarify data missing from published articles.

RESULTS: The search strategy returned 10,832 citations. After screening for relevance and duplication, 475 studies were selected for further review. All but 4 studies were excluded due to lack of a control group, OHCA patient population, literature reviews, case reports, pediatric studies, non-human subjects, or they included less than 10 IHCA patients. 4 studies of MTH after IHCA were included. 3 studies used historical controls and one study used non-randomized controls. In the 3 studies reporting sample size, a total of 51 patients received MTH compared to 70 treated with normothermia. No study reported a benefit and one study reported worse outcomes.

CONCLUSIONS: A systematic review of the literature searching for studies on outcomes of MTH after IHCA revealed 4 studies comparing MTH to controls and included a total of 121 patients. No published study showed benefit of MTH in this patient population.

CLINICAL IMPLICATIONS: AHA guidelines advise to consider the use of MTH after IHCA. Although the existing literature does not show benefit of MTH in this patient population, the published studies include only small numbers of patients and are of low quality design. A large RCT is needed to better assess the outcomes of MTH after IHCA.

DISCLOSURE: The following authors have nothing to disclose: Christina Lee, Heather Siedenburg, Daniel Fein, Shamsher Mann, Pierre Kory

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