Cardiovascular Disease |

Influence of Epidemiological Risk Factors in Development of Hypoxic Brain Injury in Patients Receiving Therapeutic Hypothermia After Cardiac Arrest: A Nationwide Analysis FREE TO VIEW

Tapan Mehta, MPH; Ronak Soni; Khushboo Sheth; Kathan Mehta, MPH
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University of Connecticut School of Medicine, Hartford, CT

Chest. 2014;146(4_MeetingAbstracts):119A. doi:10.1378/chest.1994993
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SESSION TITLE: Arrhythmia Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Cardiac arrest is one of the major causes of mortality and morbidity. The survival rates after cardiac arrest are improving with advances in Cardio-pulmonary resuscitation (CPR). Post cardiac arrest hypothermia is shown to improve survival and neurological outcomes. The role of epidemiological factors, etiological factors and co-morbid conditions influencing the neurologic outcome of therapeutic hypothermia are still debatable and requires further exploration.

METHODS: We queried the Healthcare Cost and Utilization Project’s Nationwide Inpatient Sample (NIS) between 2003 and 2011 and separated the hospitalizations due to or with cardiac arrest (ICD-9 diagnostic code 427.5) who received therapeutic hypothermia (ICD-9 procedure code 99.81). We examined the factors independently associated with increased or decreased risk of having HBI (ICD-9 diagnostic code 348.1) during the hospitalization using logistic regression model. Using SAS 9.2, Survey procedures were used to identify multivariate predictors of HBI.

RESULTS: A total of 670 patients (Weighted N = 3283) who had cardiac arrest and received therapeutic hypothermia were available for analysis. After controlling for confounders, acute myocardial infarction (OR 1.76, 95% CI 0.88-3.55), any co-existing or newly developed respiratory illness (OR 1.48, 95% CI 0.71 -3.11), diseases of pulmonary circulation including pulmonary embolism (PE) (OR 0.65, 95% CI 0.3-1.42) and cerebrovascular conditions (OR 0.63, 95% CI 0.28-1.46) were not associated with developement of HBI among the patients receiving hypothermia. Age (OR 0.99, 95% CI 0.97-1.01), female sex (OR 0.76, 95% CI 0.43-1.35), race -African American vs. White (OR 0.85, 95% CI 0.34-2.12), other vs. White (OR 0.89, 95% CI 0.39-2.03), Charlson Co-morbidity Index (OR 0.9, 95% CI 0.8-1.02), and teaching hospital status (OR 0.98, 95% CI 0.5 -1.95), hospital bedsize and hospital region also did not increase or decrease the risk of developing HBI. Intubation longer than 96 hour (OR 2.6, 95% CI 1.41-4.79, p = 0.002) was associated with increased risk of hypoxic brain injury.

CONCLUSIONS: If the patient receiving hypothermia remains intubated for more than 96 hours, the odds of having HBI is increased to 2.6 times after controlling for confounders.

CLINICAL IMPLICATIONS: While MRI or EEG can identify HBI, sometimes, patients are too unstable to obtain MRI and sedatives like propofol can interfere with EEG readings. In these situations, the results of our study could be useful to predict the odds of HBI.

DISCLOSURE: The following authors have nothing to disclose: Tapan Mehta, Ronak Soni, Khushboo Sheth, Kathan Mehta

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