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Outcomes of Mild Therapeutic Hypothermia After In-Hospital Cardiac Arrest

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Abstract

Background

Although the benefits of mild therapeutic hypothermia (MTH) in selected patients after out-of-hospital cardiac arrest have been consistently demonstrated, no controlled trial of MTH in selected patients after in-hospital cardiac arrest (IHCA) has been published. We sought to assess the benefit of MTH after IHCA in patients meeting our institutions IHCA MTH inclusion criteria.

Methods

A retrospective, historical control study was performed. During the 3-year period before and after the 2006 MTH protocol implementation at our institution, we identified a total of 118 patients admitted to our Medical Intensive Care Unit after resuscitation from an IHCA. Two blinded investigators identified all patients meeting our institutions MTH protocol inclusion criteria and the patients in each time period were compared. The primary outcome was discharge with good neurological function.

Results

33 IHCA patients met MTH protocol inclusion criteria; 16 patients were admitted prior to MTH protocol implementation and thus were not treated with MTH post arrest while 17 patients were admitted after implementation and were all treated with MTH post arrest. 91% of patients had an arrest rhythm of asystole or pulseless electrical activity. Good neurological function at discharge was found in 24% of MTH patients and 31% of controls (P = .62).

Conclusions

No difference in neurological outcome at discharge was detected in predominantly non-shockable IHCA patients treated with MTH. This finding, if confirmed with further study, may define a population of patients for whom this costly and resource intensive therapy should be withheld.

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Fig. 1

Abbreviations

MTH:

Mild therapeutic hypothermia

OHCA:

Out-of-hospital cardiac arrest

VF:

Ventricular fibrillation

VT:

Ventricular tachycardia

IHCA:

In-hospital cardiac arrest

MICU:

Medical intensive care unit

ADL:

Activities of daily living

CPC:

Cerebral performance category

DISCHCPC:

Cerebral performance category score at discharge

BESTCPC:

Best cerebral performance category score after arrest

ACLS:

Advanced cardiac life support

ROSC:

Return of spontaneous circulation

PEA:

Pulseless electrical activity

References

  1. The Hypothermia After Cardiac Arrest Study Group. Mild therapeutic hypothermia to improve the neurological outcome after cardiac arrest. N Engl J Med. 2002;346:549–56.

    Article  Google Scholar 

  2. Bernard SA, Gray TW, Buist MD, et al. Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med. 2002;346:557–63.

    Article  PubMed  Google Scholar 

  3. Oddo M, Schaller MD, Feihl F, Ribordy V, Liaudet L. From evidence to clinical practice: effective implementation of therapeutic hypothermia to improve patient outcome after cardiac arrest. Crit Care Med. 2006;34:1865–73.

    PubMed  Google Scholar 

  4. Kim F, Olsufka M, Carlborn D, et al. Pilot study of rapid infusion of 2 l of 4°C normal saline for induction of mild hypothermia in hospitalized, comatose survivors of out-of-hospital cardiac arrest. Circulation. 2005;112:715–9.

    Article  PubMed  Google Scholar 

  5. Busch M, Soreide E, Lossius HM, Lexow K, Dickstein K. Rapid implementation of therapeutic hypothermia in comatose out-of-hospital cardiac arrest survivors. Acta Anaesthesiol Scand. 2006;50:1277–83.

    Article  PubMed  CAS  Google Scholar 

  6. Sunde K, Pytte M, Jacobsen D, et al. Implementation of a standardized treatment protocol for post resuscitation care after out-of-hospital cardiac arrest. Resuscitation. 2007;73:29–39.

    Article  PubMed  Google Scholar 

  7. Nolan JP, Morley PT, Vanden Hoek TL, et al. Therapeutic hypothermia after cardiac arrest: an advisory statement by the advanced life support task force of the International Liaison Committee on Resuscitation. Circulation. 2003;108:118–21.

    Article  PubMed  CAS  Google Scholar 

  8. American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2010;122:S768–86.

    Google Scholar 

  9. Szainwald L, Ahuja J, Kory P. Mild Therapeutic Hypothermia after In-Hospital Cardiac Arrest—A Nationwide Survey of Current Practice. Slide presentation at the annual meeting of the American College of Chest Physicians. 2010.

  10. Skulec R, Truhlar A, Knor J, et al. The practice of therapeutic hypothermia in cardiac arrest survivors in the Czech Republic. Minerva Anestesiol. 2010;76:1–7.

    Google Scholar 

  11. Travers AH, Rea TD, Bobrow BJ, et al. Part 4: CPR overview: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010;122:S676–84.

    Article  PubMed  Google Scholar 

  12. Kory P, Weiner J, Mathew JP, et al. A rapid, safe, and low-cost technique for the induction of mild therapeutic hypothermia in post-cardiac arrest patients. Resuscitation. 2011;82:15–20.

    Article  PubMed  Google Scholar 

  13. Laver S, Farrow C, Turner D, Nolan J. Mode of death after admission to an intensive care unit following cardiac arrest. Intensive Care Med. 2004;30:2126–8.

    Article  PubMed  Google Scholar 

  14. Peberdy MA, Kaye W, Ornato JP, et al. Cardiopulmonary resuscitation of adults in the hospital, a report of 14720 cardiac arrests from the National Registry of Cardiopulmonary Resuscitation. Resuscitation. 2003;58:297–308.

    Article  PubMed  Google Scholar 

  15. Sacks H, Chalmers TC, Smith H. Randomized versus historical controls for clinical trials. Am J Med. 1982;72(2):233–40.

    Article  PubMed  CAS  Google Scholar 

  16. Williams GR, Spencer FC. The clinical use of hypothermia following cardiac arrest. Ann Surg. 1958;148:462–6.

    Article  PubMed  Google Scholar 

  17. Benson DW, Williams GR, Spencer FC, Yates AJ. The use of hypothermia after cardiac arrest. Anesth Analg. 1959;38:423–8.

    Article  PubMed  CAS  Google Scholar 

  18. Rittenberger JC, Guyette F, Tisherman SA, De Vita MA, Alvarez RJ, Callaway CW. Outcomes of a hospital-wide plan to improve care of comatose survivors of cardiac arrest. Resuscitation. 2008;79:198–204.

    Article  PubMed  Google Scholar 

  19. Busch M, Soreide E. Mild Induced Hypothermia after in-hospital cardiac arrest—is it worthwhile? 3rd International Hypothermia Symposium (abstract). Lund, Sweden. 2009.

  20. Arrich J. The European Resuscitation Council Hypothermia after Cardiac Arrest Registry Study Group. Clinical application of mild therapeutic hypothermia after cardiac arrest. Crit Care Med. 2007;35:1041–7.

    Article  PubMed  Google Scholar 

  21. Storm C, Nee J, Rose M, Achim J, Dietrich H. Mild hypothermia treatment in patients resuscitated from non-shockable cardiac arrest rhythms. Emerg Med J. 2011.doi:10.1136/emj.2010.105171.

  22. Herlitz J, Bang A, Aune S, Lundstrom G, Holmberg S. Characteristics and outcome among patients suffering in hospital cardiac arrest in monitored and non-monitored areas. Resuscitation. 2001;48:125–35.

    Article  PubMed  CAS  Google Scholar 

  23. Dumas F, Grimaldi D, Zuber B, et al. Is hypothermia after cardiac arrest effective in both shockable and non-shockable patients? Insights from a large registry. Circulation. 2011;123:877–86.

    Article  PubMed  Google Scholar 

  24. Hachimi-Idrissi S, Corne L, Ebinger G, Michotte Y, Huyghens L. Mild hypothermia induced by a helmet device: a clinical feasibility study. Resuscitation. 2001;51:275–81.

    Article  PubMed  CAS  Google Scholar 

  25. Oddo M, Ribordy V, Feihl F, et al. Early predictors of outcome in comatose survivors of ventricular fibrillation and non-ventricular fibrillation cardiac arrest treated with hypothermia: a prospective study. Crit Care Med. 2008;36:2296–301.

    Article  PubMed  Google Scholar 

  26. Don CW, Longstreth WT, Maynard C, et al. Active surface cooling to induce mild therapeutic hypothermia after out-of-hospital cardiac arrest: a retrospective before-and-after comparison in a single hospital. Crit Care Med. 2009;37:3062–30693.

    Article  PubMed  Google Scholar 

  27. Storm C, Steffen I, Schefold JC, et al. Mild therapeutic hypothermia shortens intensive care unit stay of survivors after out-of-hospital cardiac arrest compared to historical controls. Crit Care. 2008;12:R78.

    Article  PubMed  Google Scholar 

  28. Bernard SA, Jones BM, Horne MK. Clinical trial of induced hypothermia in comatose survivors of out-of-hospital cardiac arrest. Ann Emerg Med. 1997;30:146–53.

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

No external sources of funding were used in the execution of this study. The authors thank Dr. Phillip Factor, Chief of the Division of Pulmonary, Critical Care, and Sleep Medicine for his assistance and support in the preparation of this manuscript.

Conflict of interest

No author has any personal, financial, or potential conflict of interest with any material presented in this manuscript.

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Correspondence to Pierre Kory.

Additional information

All work was performed at Beth Israel Medical Center, New York.

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Kory, P., Fukunaga, M., Mathew, J.P. et al. Outcomes of Mild Therapeutic Hypothermia After In-Hospital Cardiac Arrest. Neurocrit Care 16, 406–412 (2012). https://doi.org/10.1007/s12028-011-9664-y

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  • DOI: https://doi.org/10.1007/s12028-011-9664-y

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