Abstract 105: What Patients Don't Get Therapeutic Hypothermia After Cardiac Arrest
Introduction: Current American Heart Association (AHA) Recommendations identify post cardiac arrest Therapeutic Hypothermia(TH) as a 2A recommendation for VT/VF arrest and a 2B recommendation for other rhythms and in hospital cardiac arrest. Interpretation of these recommendations results in inconsistent application of TH to these patients.
Objective: 1)To identify outcomes of patients post cardiac arrest who receive or don't received therapeutic hypothermia (TH) and 2)Identify reasons for non-provision of TH in this population.
Methods: Retrospective Record review of Out of Hospital Cardiac Arrest patients from 2007– 2009 at a single large academic community hospital. The hospital has had a TH program in place since 2005, with policies for use mirroring AHA recommendations. Study authors reviewed all charts and abstracted presumptive reason for non-administration of TH. Elements reviewed included patient demographics, arrest etiology, initial arrest rhythm, time to ROSC, patient pre-arrest comorbidities, and clinical note discussing therapies. Current AHA TH recommendations were used for analysis regarding whether patient met criteria for withholding of TH.
Results: There were 103 post arrest patients. Overall , 40 (38.8%) received TH and of these 17(42.5%) survived to discharge with VF survival of 15/20(75%). Of the 63 not receiving TH, 8 were not comatose and 18 had overt contraindications to TH (Trauma/Surgical Care=2; DNR order or terminal illness =9; Prolonged CPR or hemodynamic instability=7). Of the remainder, reasons for not providing TH were abstracted as follows: Age ≥ 80 (N=9); Presumed Brain Death in ED (N=2); Non-cardiac etiology of arrest (N=10);PEA/asystole arrest (N=10); none clearly identified (n=6). Of the 37 patients in this group, 9 (24.3%) survived to discharge.
Conclusions: A minority of patients in this population received TH. If AHA criteria were strictly applied an additional 37 patients would have received TH. These data suggest that physicians are reluctant to institute TH for patients with age > 80, non VF arrest or presumptive non cardiac arrest. Further work is needed to identify barriers to optimal provision of Therapeutic Hypothermia to post cardiac arrest patients.
- © 2010 by American Heart Association, Inc.