Abstract 232: Early Withdrawal of Post-Arrest Care After Therapeutic Hypothermia in Victims of Out-of-Hospital Cardiac Arrest
Objective: Current guidelines state that neurologic prognosis after out-of-hospital cardiac arrest (OHCA) cannot be reliably assessed within 72 hours of the completion of therapeutic hypothermia (TH). We sought to assess regional variation in frequency and timing of withdrawal of care after OHCA in a statewide system of cardiac receiving centers (CRCs).
Methods: Analysis of a prospective cohort of patients with OHCA treated in one of 26 state health department-recognized CRCs. Data were entered into a standardized statewide post-arrest care database. All CRCs have protocols with a moratorium on withdrawal of care for at least 72 hours after TH. To assess whether this aspect of the protocol is being complied with, we evaluated the timing of withdrawal of care. SAS version 9.1.3 (SAS Institute Inc., Cary, NC) was used for analysis.
Results: Included were 1,292 adult (age ≥18 years) patients who had OHCA between 12/14/07 and 12/31/09. Mean age was 61.3 years (SD ± 18.4) and 471 (36.5%) were female. 702 (54.3%) were excluded because they died in the ED. 590 patients were admitted and 298 (50.5%) received therapeutic hypothermia (TH). Of these, 118 (40.0%) survived to hospital discharge. Of the 177 patients admitted to the ICU and cooled, care was withdrawn on 59 (33.3 %) within 24 hours, 53 (29.9%) between 25–72 hours, and 45 (25.4%) after 72 hours.
Conclusions: The timing of withdrawal of care after TH is highly variable and early withdrawal of care is common even in a system of CRCs with specific protocols aimed at preventing early withdrawal. Additional emphasis on continuing care in post-TH patients is warranted.
- © 2010 by American Heart Association, Inc.