Abstract 2628: Emergency Department-Based Post-Arrest Therapeutic Hypothermia and Early Goal-Directed Resuscitation is Feasible
Study Objectives: Early Goal-Directed Therapy improves outcomes in patients with severe sepsis and septic shock. The post-resuscitation state in patients with Return of Spontaneous Circulation (ROSC) after Out-Of-Hospital Cardiac Arrest (OHCA) has been likened to a sepsis-like syndrome. Based on this physiologic similarity we implemented a post-arrest Therapeutic Hypothermia and Early Goal-Directed Resuscitation (THEGDR) protocol for survivors of OHCA. In this study we sought to examine the feasibility of performing this novel resuscitation approach.
Methods: In May, 2005 we began prospectively identifying comatose (Glasgow Motor Score < 6) survivors of OHCA treated with our THEGDR protocol. More than 150 data points were recorded including pre-hospital data, ED interventions, time to ROSC, time to target temperature, times and values of initial and goal THEGDR goals (CVP 8 –12 mmHg; MAP 80 –100 mmHg; ScvO2 > 65%), in-house mortality, and discharge neuro-functional status based upon Cerebral Performance Class (CPC).
Results: Between May, 2005 and May, 2007 21 patients were eligible; 13 patients were enrolled. Mean initial CVP was 12 mmHg (range 8 –22 mm Hg); mean initial MAP was 101 mmHg (range 57–127 mm Hg); mean initial ScvO2 was 84% (range 82–90%); mean time to target temperature (33°C) was 4.5 hours (range 2–9 hrs) from ROSC; 46% (5/13) had interventions based upon THEGDR parameters; 92% (12/13) of patients achieved their THEGDR goals within 6 hours of ROSC. Pre-implementation mortality was 69%; post-implementation mortality was 46% (6/13); 54% (7/13) survived to hospital discharge; 38% (5/13) were discharged neurologically intact (CPC=1–2).
Conclusion: Post-cardiac arrest early goal-directed resuscitation while inducing therapeutic hypothermia is feasible. Further studies are needed to determine if post-cardiac arrest goal-directed resuscitation improves outcome.