Abstract 26: Predictor of Neurologic Outcome in Mild Hypothermia After Cardiac Arrest. : Age<70 and Ventricular fibrillation in initial rhythm were the positive predictive value and shock was the negative predictive value of neurologic outcome.
Background) To evaluated the efficacy of mild hypothermia therapy (MT) and investigate the predictor of neurologic outcome.
Methods) Inclusion criteria of this study were as follows.
Documented cardiopulmonary arrest (CPA)
Successful return of spontaneous circulation (ROSC) after appropriate BLS and ACLS
Without hemorrhagic disorder
Persistent come after ROSC
Good ADL before cardiac arrest, age under 80 yrs.
All cases were referred to catheter laboratory, emergency coronary angiography was performed immediately after ROSC.
In the case acute coronary syndrome, percutaneous coronary intervention was subsequently performed if needed.
Intra-aortic balloon pumping (IABP) with or without Percutaneous Cardio-Pulmonary Bypass System (PCPS) was performed in patients (pts) with shock in spite of conservative therapy Mild hypothermia(MH) was performed with cooling temperature of 34°C for 1~2 days.
Results) In the historical control group, from May 1998 to May 2001, 53 pts in CPA and ROSC were met the above criteria and treated with normothermia therapy (NT). The mean time until ROSC 33±18 min. Survival at hospital discharge was 22 pts (42 %), and favorable neurologic outcome (GR: Good recovery and MD: Moderate disability) was achieved 7pts (13.2%). From June 2001 to April 2007, eligible 65 pts were cooled after ROSC. The mean time of CA-CPR was 5±4 min (p=NS), and mean time until ROSC 34±23 min (p=0.8031, compared to NT group). Of those 65 pts, favorable neurologic outcome patients after MT were seen in 33pts (50.8%, p<0.0001). In the multivariate analysis, the significant predictors of favorable outcome after MH were Age>70 (Relative Risk (RR) 7.95) and Ventricular fibrillation (Vf) in the initial rhythm (RR 5.59), on the other hand, hemodynamic compromise state (RR 0.14) after ROSC was the negative predictive value.
Conclusion) Compared with NT, MH was considered to be effective for the patients with CPA-survivor patients. Age<70 and Vf were the positive, and shock was the negative predictive value of neurologic outcome.