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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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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

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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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Authors and Affiliations

  1. Division of Pulmonary and Critical Care Medicine, Beth Israel Medical Center, 7 Dazian, 16th St., 1st Ave, New York, NY, USA

    Pierre Kory

  2. Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Medical Center, New York, NY, USA

    Pierre Kory, Mayuko Fukunaga, Joseph P. Mathew, Bimaljeet Singh, Lisa Szainwald, Joseph Mosak, Mathew Marks, Dana Berg, Meir Saadia, Annie Katz & Paul H. Mayo

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  1. Pierre Kory
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  2. Mayuko Fukunaga
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  11. Paul H. Mayo
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Corresponding author

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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