Critical Care |

How Cold Is Cold Enough? Retrospective Review of Therapeutic Hypothermia Outcomes and Protocol Revision in a Community-Based Hospital FREE TO VIEW

David Aggen, MD; Meena Azeem, MD; Shahniwaz Labana, MD; Roman Barraza, MD; Cesar Hidalgo, MD; Sarwan Kumar, MD; Ahmad Ghabsha, MD
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Wayne State University, Rochester Hills, MI

Chest. 2015;148(4_MeetingAbstracts):241A. doi:10.1378/chest.2229751
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SESSION TITLE: Critical Care Posters II

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: Post-cardiac arrest therapeutic hypothermia with target temperature between 32 to 34 degrees C has been validated in numerous international randomized control trials. Our community-based hospital has successfully implemented a hypothermia protocol for comatose patients with a Glasgow Coma Scale of < 6 post-cardiac arrest since 2006 without significant revisions since implementation. This retrospective study was designed to assess neurologic outcomes following therapeutic hypothermia and revise our current hypothermia protocol.

METHODS: We performed a retrospective chart review of all patients between 2012 and 2014 who required the use of a hypothermia vest at a single-center. Based on clinical documentation a Pittsburgh Cerebral Performance Category (CPC) Score was designated for each patient at discharge.

RESULTS: Between 2012-2014 we identified 28 patients who required a hypothermia vest and 20/28 patients who were cooled to < 34 degrees C for 24 hours. 9/20 (45%) patients had CPC Scores between 1 and 3 at discharge indicative of favorable neurologic outcomes. 8/28 patients were cooled for < 24 hours due to contraindications to traditional therapeutic hypothermia (bleeding, sustained hypotension, or neurologic recovery): 3/8 patients were made comfort care due to persistent comatose states, 2/8 patients had CPC scores of 3 or 4 at discharge to long-term acute care facilities, and 3/8 patients were discharged to home with CPC scores of 1 or 2.

CONCLUSIONS: We demonstrate the feasibility of performing therapeutic hypothermia in a community-based hospital with recovery rates comparable to those reported in randomized trials at tertiary care centers. A recent clinical trial by Nielsen et al. (NEJM, 2013) demonstrated non-inferiority in cooling patients to 36 degrees C compared to the traditional target of 32-34 degrees C. In a 2-year period at our hospital, 8 patients were not maintained at therapeutic hypothermia temperatures for 24 hours, 5 of whom may have benefitted from permissive hypothermia (< 36 degrees C). Here we demonstrate precedent for and present a strategy to revise our hypothermia protocol to target patients who may benefit from permissive hypothermia.

CLINICAL IMPLICATIONS: Therapeutic hypothermia is feasible in a community hospital setting. We are revising our therapeutic hypothermia protocol to include a permissive hypothermia target, with a goal of maintaining a temperature of < 36 degrees C for 24 hours post-arrest in comatose patients with contraindications to traditional hypothermia.

DISCLOSURE: The following authors have nothing to disclose: David Aggen, Meena Azeem, Shahniwaz Labana, Roman Barraza, Cesar Hidalgo, Sarwan Kumar, Ahmad Ghabsha

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