Abstract P99: Efficacy and Side Effects of Mild Induced Hypothermia after Out-of-hospital Sudden Cardiac Arrest in Non-Selected Patients
Background and Purpose: Sudden cardiac arrest (SCA) remains one of the single leading causes of death. Cognitive deficits are common in survivors of SCA. Postresuscitative mild induced hypothermia (MIH) lowers mortality and reduces neurologic damage after cardiac arrest. We evaluated the efficacy and side effects of therapeutic hypothermia in an unselected group of patients after SCA.
Methods: 30 consecutive patients with restoration of spontaneous circulation (ROSC) after resuscitation due to out-of-hospital SCA, who where admitted to our intensive care unit, underwent MIH. Hypothermia was induced by infusion of cold saline and whole-body-cooling methods (invasive or non-invasive). The core body temperature was operated at 32 to 34 °C over a period of 24 hours followed by active rewarming. Neurological status was evaluated at hospital discharge using the Pittsburgh Cerebral Performance Category (CPC).
Results: Overall, 30 patients (mean age 63±5 years, 80% male) were included in this study with a “no- or low-flow” duration of 35 min (SCA to ROSC). The APACHE II-Score at admission was 24.0±4.6. Left ventricular ejection fraction was 36.5±14.0. Eighty percent SCA’s were witnessed by bystanders. In 47% resuscitation was initiated before arriving of emergency services. Because 67% of all patients were firstly admitted to a non-tertiary center, the time from SCA to target temperature was 452±252 min. Survival rate at discharge was 67%. Fifty percent of all patients presented in good neurologic functional status (CPC 4 –5). Infectious complications were observed in 58% of our non-selected patients, mostly nosocomial pneumonia (73%), with five patients developing a severe sepsis (8%) and a sepsis-related mortality of 40% (2 of 5 patients). Antibiotic prophylaxis was not given in any patient. 47% of all patients suffered renal failure with a necessity of dialysis in 20%.
Conclusions: Neurologic outcome after out-of-hospital sudden cardiac arrest remains poor. Treating non-selected patients who have been successfully resuscitated with MIH is proven effective and safe. However, in a real-world scenario including older patients with more co-morbidities than in randomized trials this is associated with multiple secondary infectious complications.