Abstract P97: Standardized Post Resuscitation Care including Therapeutic Hypothermia for Patients with Non-VF Arrests
Introduction: Whether therapeutic hypothermia (TH) improves survival after out-of-hospital cardiac arrest (OHCA) with initial asystole (AS) or pulseless electrical activity (PEA) is still controversial. At our hospital, revived OHCA patients follow the same standardized post resuscitation care protocol, if active treatment is desired. This includes TH, irrespectively of initial rhythm. Thus, we wanted to report the outcome for our OHCA patients of non-VF origin.
Methods: Since September 2003 all OHCA patients admitted to our hospital have been registered in a database. All patients with initial AS or PEA admitted to the Intensive Care Unit (ICU), or ward, between September 2003 and July 2007 were included. Favorable outcome is defined as a Cerebral Performance Category (CPC) of 1–2.
Results: Altogether 58 patients, all comatose, with a median age of 55 (range 19 –90 years), were registered. Cardiac etiology was present in 24 patients (41%), half of which had a myocardial infarction. Among the 34 patients (59%) with non-cardiac etiology, 15 were intoxications (44%), seven had asphyxia after respiratory failure (21%), five had suffered a cerebral event (15%), three drowned (9%), one had a pulmonary embolism (3%), and three causes remained unidentified. Overall, 37 patients (67%) were treated with TH; 16 (43%) received external cooling (Arctic Sun, Medivance), 13 (35%) endovascular cooling (Coolgard, Alsius Corporation) and eight (22%) other external cooling, all methods combined with initial ice cold fluids/ice packs. Median time in ICU was three days (range 0 –19 days). Eleven patients (19%) were discharged alive from hospital (cardiac etiology in four, 36%). Nine patients (16%) had a favorable outcome, and two patients (3%) had CPC 3.
Conclusion: After implementation of standardized post resuscitation care including TH, we found a 16% favorable survival among those admitted after non-VF OHCA, demonstrating a survival potential also for these patients.