Abstract 131: Do Healthy Patients Receive More Hypothermia?
Background: Therapeutic hypothermia (TH) is an effective adjunctive therapy to standard post-resuscitation care for neurologically unresponsive survivors of cardiac arrest. TH has been demonstrated to improve survival and functional outcomes in this vulnerable patient population in a variety of academic and community hospital settings. However, little is known about the decision to select patients for receiving TH.
Methods: TH was initiated on an ad hoc basis for comatose survivors of cardiac arrest in our 511-bed community teaching hospital with an evidence-based protocol for TH delivery in the intensive care unit (ICU) setting. With IRB approval, we conducted a retrospective chart review to evaluate TH application and outcomes for appropriate patients according to the Utstein style for research on post-resuscitation care.
Results: In a consecutive 16-month period, 5 of 33 patients (15%) eligible for the TH protocol in our institution had TH initiated. Comparing TH and non-TH groups, there were no significant differences in baseline demographics and comorbidities, including age, BMI, prior cardiac arrest, prior myocardial infarction, angina, heart failure, lung disease, diabetes, renal disease, liver disease, smoking, substance abuse, Cerebral Performance Categories score, and Overall Performance Categories score (p=NS). However, 4 TH patients (80%) and 6 non-TH patients (21%) were considered “healthy” prior to cardiac arrest (p=.01).
Conclusions: In a community teaching hospital with an ICU-centered TH program and no formal screening mechanism for emergency department (ED) patients, a subjective assessment of prior health may have influenced the decision for medical staff to offer TH therapy to comatose survivors of cardiac arrest. This subjective assessment was incongruous with the actual presence of comorbid conditions that may influence survival and neurological outcomes. A defined evidence-based screening tool in ED and ICU settings may eliminate subjective disparities in TH initiation, and should be evaluated to assess for impacts on TH initiation and patient outcomes.
- © 2010 by American Heart Association, Inc.