Abstract P207: “Cool It”: Therapeutic Hypothermia for Cardiac Arrest Patients Transferred From Outstate Emergency Departments
Background: Recent trials have shown that therapeutic hypothermia (TH) reduces mortality and improves neurological outcome in comatose survivors of cardiac arrest. The absence of organized systems of emergency care prevents widespread implementation of TH in the United States. There is little data on TH in transfer patients.
Methods: Utilizing referral relationships with 30 community hospitals, the Cool It program established a regional TH system involving a coordinated transfer plan between outstate emergency departments (EDs) up to 200 miles from a tertiary center capable of TH. Patients unconscious following cardiac arrests were cooled to 33°C for 24 hours. Cerebral function after TH was measured by the five point Pittsburgh Cerebral Performance Category (CPC) scale in which CPC 1 and 2 are positive neurological outcomes.
Results: From 2/06 to 4/09, 122 patients were cooled, 91 of which were transferred from outstate hospitals. In comparing patients presenting to the TH capable facility with those presenting to referring hospital EDs, no difference occurs in survival (55% vs. 59%, p=0.81) or positive neurological outcome (82% vs. 94%, p=0.14). See table below compairing Kaplan-Meier survival in transfers and non-transfers.
Conclusion: The transfer of TH pts does not compromise survival or neurological recovery following OOHCA. With this data, TH becomes a more relevant standard of care for OOHCA and should be a part of every large acute MI and cardiovascular emergency transfer program.