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Therapeutic Hypothermia After Resuscitation From a Non-Shockable Rhythm Improves Outcomes in a Regionalized System of Cardiac Arrest Care

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Abstract

Objective

Therapeutic hypothermia (TH) improves neurologic outcome in patients resuscitated from ventricular fibrillation. The purpose of this study was to evaluate TH effects on neurologic outcome in patients resuscitated from a non-shockable out-of-hospital cardiac arrest rhythm.

Design and Setting

This is a retrospective cohort study of data reported to a registry in an emergency medical system in a large metropolitan region. Patients achieving field return of spontaneous circulation are transported to designated hospitals with TH protocols.

Patients

Patients with an initial non-shockable rhythm were identified. Patients were excluded if awake in the Emergency Department or if TH was withheld due to preexisting coma or death prior to initiation. The decision to initiate TH was determined by the treating physician.

Measurements

The primary outcome was survival with good neurologic outcome defined by a cerebral performance category of 1 or 2.

Main Results

Of the 2772 patients treated for cardiac arrest during the study period, there were 1713 patients resuscitated from cardiac arrest with an initial non-shockable rhythm and 1432 patients met inclusion criteria. The median age was 69 years [IQR 59–82]; 802 (56 %) male. TH was induced in 596 (42 %) patients. Survival with good neurologic outcome was 14 % in the group receiving TH, compared with 5 % in those not treated with TH (risk difference = 8 %, 95 % CI 5–12 %). The adjusted OR for a CPC 1 or 2 with TH was 2.9 (95 % CI 1.9–4.4).

Conclusion

Analyzing the data collected from the registry of the standard practice in a large metropolitan region, TH is associated with improved neurologic outcome in patients resuscitated from initial non-shockable rhythms in a regionalized system for post-resuscitation care.

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Acknowledgments

The authors would like to thank all the cardiac arrest center participants and the Los Angeles County EMS Agency staff, in particular Paula Rashi, Richard Tadeo, and Deidre Gorospe, who contributed to the ROSC registry and whose dedicated work provided the necessary data for this analysis.

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Authors and Affiliations

  1. Department of Neurology, Keck School of Medicine of the University of Southern California, 1520 San Pablo St, Ste 3000, Los Angeles, CA, 90033, USA

    Gene Sung

  2. Department of Emergency Medicine, Harbor-UCLA Medical Center, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA, USA

    Nichole Bosson, Amy H. Kaji & James T. Niemann

  3. David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

    Nichole Bosson, Amy H. Kaji, William J. French, Joseph L. Thomas & James T. Niemann

  4. Los Angeles County Emergency Medical Services Agency, Los Angeles, CA, USA

    Nichole Bosson & William Koenig

  5. Department of Emergency Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA

    Mark Eckstein

  6. Department of Cardiology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA

    David Shavelle

  7. Department of Cardiology, Harbor-UCLA Medical Center, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA, USA

    William J. French & Joseph L. Thomas

Authors
  1. Gene Sung
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  2. Nichole Bosson
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  3. Amy H. Kaji
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  4. Mark Eckstein
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  7. Joseph L. Thomas
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  8. William Koenig
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  9. James T. Niemann
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Correspondence to Gene Sung.

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Sung, G., Bosson, N., Kaji, A.H. et al. Therapeutic Hypothermia After Resuscitation From a Non-Shockable Rhythm Improves Outcomes in a Regionalized System of Cardiac Arrest Care. Neurocrit Care 24, 90–96 (2016). https://doi.org/10.1007/s12028-015-0184-z

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  • DOI: https://doi.org/10.1007/s12028-015-0184-z

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