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Outcomes in Cardiac Arrest Patients due to Toxic Exposure Treated with Therapeutic Hypothermia


The incidence and outcome of patients who undergo therapeutic hypothermia (TH) after toxin-induced cardiac arrest (TICA) is not previously described. Our study aimed to describe the incidence, epidemiologic characteristics, and outcomes of patients who experience TICA in a dedicated clinical pathway for post-cardiac arrest care between November 2007 and February 2013. All patients were treated in an evidence-based clinical pathway that included TH. Database and medical records were independently reviewed by investigators to ascertain TICA. TICA was defined as cardiac arrest (CA) directly and immediately caused by a xenobiotic exposure. All patients were enrolled at Carolinas Medical Center, an urban 874-bed teaching hospital that serves as a regional cardiac resuscitation center. All patients were adult victims of cardiac arrest who had obtained return of spontaneous circulation and were enrolled in a clinical pathway for post-cardiac arrest care that included TH. Three hundred eighty-nine patients underwent treatment following CA during the study period and 48 (12 %) were deemed TICA. Patients who suffered TICA were slightly younger, less likely to have an initial shockable rhythm, and less likely to receive bystander CPR as compared to non-toxic cases. TICA accounted for a significant proportion of patients in this study. Additional, larger studies are needed to fully elucidate the optimal role for TH in TICA.

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Colleen H. Karvetski, PhD

Senior Health Services Researcher

Dickson Advanced Analytics

Carolinas HealthCare System

Indira Gowda, MD

Emergency Medicine Resident

Icahn School of Medicine at Mt. Sinai

New York, NY

Mike Gibbs, MD

Chair, Department of Emergency Medicine

Carolinas Medical Center

Charlotte, NC

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Correspondence to Katharine L. Modisett.

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We have no sources of funding to disclose.

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All authors deny any conflict of interest.

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Previous Presentations of Work

“Outcomes in Cardiac Arrest Patients Due to Toxic Exposure Treated With Therapeutic Hypothermia (ToxiCool).” Platform presentation. Society for Academic Emergency Medicine (SAEM) Annual Meeting. Dallas, TX. May 15, 2014.

“Outcomes in Cardiac Arrest Patients Due to Toxic Exposure Treated With Therapeutic Hypothermia (ToxiCool).” Platform presentation. American College of Medical Toxicology (ACMT) Annual Scientific Meeting. Phoenix, AZ. March 30, 2014.

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Modisett, K.L., Walsh, S.J., Heffner, A.C. et al. Outcomes in Cardiac Arrest Patients due to Toxic Exposure Treated with Therapeutic Hypothermia. J. Med. Toxicol. 12, 263–269 (2016).

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