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Outcomes of Mild Therapeutic Hypothermia After In-Hospital Cardiac Arrest

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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.


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.


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).


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



Mild therapeutic hypothermia


Out-of-hospital cardiac arrest


Ventricular fibrillation


Ventricular tachycardia


In-hospital cardiac arrest


Medical intensive care unit


Activities of daily living


Cerebral performance category


Cerebral performance category score at discharge


Best cerebral performance category score after arrest


Advanced cardiac life support


Return of spontaneous circulation


Pulseless electrical activity


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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.

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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.

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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).

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