Abstract P96: Emergency Department Population Based Study of Outcomes and Clinical Characteristics of Patients With Cardiac Arrest Before and After Implementation of an Institutional Program for Induced Hypothermia in Comatose Survivors
Objectives: Efficacy of induced hypothermia in comatose survivors of cardiac arrest (CA) has been demonstrated in clinical trials, but data on effectiveness of implementation in clinical practice are scarce. We characterized the proportion of favorable neurological outcomes after CA and frequency of use of hypothermia in a well defined emergency department (ED) population.
Methods: IRB exemption obtained.
Study period: 20 months preceding & following implementation of ED initiated endovascular cooling in comatose survivors of CA.
Subjects: consecutive patients with “cardiac arrest” identified in the ED log. Pediatric & traumatic CA excluded.
Data collection: linked institutional clinical/administration data sets and explicit chart review by trained abstracters.
Results: Among 292 consecutive arrests, 133 were treated before and 159 after implementation of the cooling protocol. Unchanged before and after were age (62 y), gender (33% female), and length of stay (9.5 days). Survival to hospital admission and hospital discharge was 33% and 16% before and 47% and 22% after implementation. Among all adults with nontraumatic CA evaluated in the ED, favorable neurological outcome (CPC 1 or 2 at discharge) occurred in more patients after implementation of the cooling protocol (29, 18%) than before (13, 10%, p=0.04). In patients without a favorable outcome, death (usually neurological) was the most common outcome (94%) across all groups. Moderate/severe disability (CPC 3 or 4 at discharge) was rare before (7%) and after (4%) implementation. After implementation 47% of those surviving to hospital admission were cooled. Among 41 patients not cooled, 6 were not comatose, 6 were surgical, 6 were septic shock, 5 had terminal cancer, 4 were unwitnessed, 2 went on ECMO, 2 were transfers >8 hours post CA, 2 were failures to place the cooling catheter, 2 were device unavailability, 2 were in status epilepticus, and in 4 specific exclusion were not identified. Among 34 comatose survivors of CA that were cooled, 18 (53%) had a favorable neurological outcome (CPC 1 or 2) at followup.
Conclusion: ED population based data are consistent with improved proportions of favorable neurological outcomes after implementation of a program of endovascular cooling initiated in the ED.