Abstract 13937: Efficacy of Early Induction of Therapeutic Hypothermia for Patients with Return of Spontaneous Circulation after Out-of-Hospital Cardiac Arrest (J-PULSE-Hypo Study)
Background: Preclinical and clinical evidence strongly supports mild therapeutic hypothermia as an effective therapy for the post-cardiac arrest syndrome. Animal data has demonstrated that the sooner cooling is initiated after return of spontaneous circulation (ROSC) from cardiac arrest, the better the outcome, although an impressive therapeutic benefit was seen in clinical studies when cooling was delayed for several hours. It is not known whether the neurologically intact survival rate will increase if the cooling is initiated on arrival at the emergency room.
Methods: We did a multicenter observational study of therapeutic hypothermia for unconscious adult patients with return of spontaneous circulation (ROSC) after out-of-hospital cardiac arrest. The J-PULSE Hypothermia committee entrusted each hospital with the timing of cooling, cooling methods, target temperature, duration, and rewarming rate. The primary endpoint was favorable neurological outcome at hospital discharge.
Results: Of the 452 unconscious adult patients who were treated with therapeutic hypothermia, 304 who were cooled to 34 °C after ROSC from out-of-hospital cardiac arrest due to ventricular fibrillation were included; 159 received hypothermia using rapid intravenous (IV) infusion of ice-cold 0.9% saline or Ringer's lactate. Hypothermia was maintained using external devices or extracorporeal devices (IV group). 145 received hypothermia without IV cold fluid. Hypothermia was maintained using external devices or extracorporeal devices (non-IV group). The time interval from collapse to initiation of the cooling was shorter in the IV group than in the non-IV group (a median; 53 minutes vs.165 minutes, p<0.0001). The IV group had higher frequency of favorable neurological outcome than the non-IV group (69.8% vs.55.9%, p=0.012). A multiple logistic-regression analysis showed that the adjusted odds ratio for favorable neurological outcome after the IV group was 1.83 (95% CI, 1.14–2.93, p=0.012).
Conclusion: Early initiation of cooling using rapid intravenous infusion with ice-cold fluid had neurological benefits for patients with ROSC after out-of-hospital cardiac arrest due to ventricular fibrillation.
- © 2010 by American Heart Association, Inc.