Abstract 279: Evaluation of Prehospital Therapeutic Hypothermia for Comatose Resuscitated Patients in Japanese Doctor-Car System
Background: Mild therapeutic hypothermia (MTH) has been integrated to improve the neurological outcome in out-of-hospital cardiac arrest. Several studies reported the effectiveness of prehospital MTH with rapid infusion of cold intravenous fluids as soon as possible after return of spontaneous circulation. But there have been no methods and trials about cooling from prehospital in Japanese emergency medical service system. The aim of this study is to evaluate the effect and safety of MTH from prehospital in doctor-car system on the outcome of out-of-hospital cardiac arrest patients.
Methods: From June 2009 to March 2010, 11 comatose resuscitated patients were enrolled, including those with initial rhythms of VF or asystole or pulseless electrical activity. They received an infusion of 400 to 2000 ml of ice cold-Ringer′s solution before hospital arrival. They were treated with MTH at 34°C for 24 hours after admission. They were compared with historical conventional patients who received cooling after admission to the hospital.
Results: The tympanic temperatures of prehospital cooling patients were lower (35.0°C vs. 35.8 °C, median) and time interval to target temperature was shorter (170 minutes vs. 250 minutes, median). Prehospital cooling was not associated with adverse events in terms of vital signs, pulmonary congestion, and cardiac rearrest. The patients treated with prehospital cooling tended to improve neurological outcome as determined by Cerebral Performance Category Score of 1 or 2 (54.5% vs. 40.7%).
Conclusions: These preliminary results indicate that the therapeutic hypothermia with prehospital cooling is useful and safety, and will be important for improvement of prognosis of the comatose resuscitated patients from cardiac arrest.
- © 2010 by American Heart Association, Inc.