Abstract P41: Outcome 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 major 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: 139 consecutive patients with restoration of spontaneous circulation (ROSC) after resuscitation due to out-of-hospital SCA, 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, 139 patients (mean age 65±14 years, 79% male) were included with a “no-or low-flow” duration of 35 min (SCA to ROSC). SCA was bystander-witnessed in 86%. In 69% resuscitation was initiated before arriving of emergency services. Because 68% of all patients were firstly admitted to non-tertiary centers, the time from ROSC to target temperature was 455±621 min. Survival rate at discharge was 61%. Thirty-four percent of all patients presented in good neurologic functional status (CPC 1–2). Infectious complications were observed in 76% of our non-selected patients, mostly nosocomial pneumonia (79%), with 21 patients developing a severe sepsis (15%) and a sepsis-related mortality of 34% (7 of 21 patients). Antibiotic prophylaxis was not given in any patient. 58% of all patients suffered renal failure with a necessity of dialysis in 25%.
Conclusions: Neurologic outcome after out-of-hospital sudden cardiac arrest remains poor. Treating non-selected patients successfully resuscitated with MIH is proven effective and safe. However, the high rate of complications compared to other published studies may be a result of our real-world scenario including older patients with more comorbidities that is associated with multiple secondary infectious complications. Furthermore, the different definitions of complications might have an impact.