Abstract 15755: Hypothermia After Cardiac Arrest: Effective in Both Shockable and Non-Shockable Patients?
Introduction: Management of out-of-hospital cardiac arrest (OHCA) survivors routinely includes mild therapeutic hypothermia (MTH) in order to improve cerebral outcome. Although the level of evidence of improvement is high in patients resuscitated from a shockable rhythm (Ventricular Fibrillation or pulseless Ventricular Tachycardia: VF/VT), data are more controversial in non shockable patients (Pulseless Electrical Activity or asystole: PEA/asystole). We therefore assessed the prognostic value of hypothermia on neurological outcome at hospital discharge according to first recorded cardiac rhythm.
Methods: Between Jan 2000 and Dec 2009, 1145 consecutive OHCA patients in whom a successful resuscitation has been achieved were admitted to our intensive care unit in Paris (France). All clinical and biological characteristics during pre-hospital care and intensive care unit stage were prospectively collected. The association of MTH with a good neurological outcome at hospital discharge (Cerebral Performance Categories-CPC- level 1 or 2) was quantified by logistic regression.
Results: Among the 1145 successfully resuscitated OHCA, 708 (68%) had an initial VF/VT rhythm. MTH was induced in 457/708 pts (65%) in VF/VT and 261/437 pts (60%) in asystole/PEA. Overall 345/1145 pts (30%) reached a CPC level 1 or 2 at hospital discharge, respectively 274/708 (39%) in VF/VT and 68/437 (16%) in asystole/PEA (p<0.001). In VF/VT patients, the use of MTH was positively related to good outcome (OR=1.90; CI95% [1.18–3.06]) after adjustment for pre- and in-hospital covariates. By contrast, in asystole/PEA patients, the use of MTH tended to be inversely associated with good outcome, although it did not reach statistical significance (adjusted OR=0.71; CI95% [0.37–1.36]).
Conclusions: In this large cohort of OHCA patients, induced MTH was independently associated with a better neurological outcome at hospital discharge in patients presenting a shockable rhythm (VF/VT). By contrast, this benefit was absent in non-shockable patients, in whom MTH tended to be associated with a worse neurological outcome. Further investigations are needed to clarify this lack of efficiency in PEA/asystole.
- © 2010 by American Heart Association, Inc.