Abstract 285: The Relationship Between Time Interval From Collapse to Return of Spontaneous Circulation and Neurologically Intact Survival for Patients Treated With Hypothermia After Non-Ventricular Fibrillation Arrest Out of Hospital. J-PULSE-Hypo Registry
Background: Clinical evidence strongly supports mild therapeutic hypothermia for unconscious patients with out-of-hospital cardiac arrest due to ventricular fibrillation (VF), but there are insufficient data that hypothermia had neurological benefit for those with non-VF arrest.
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 timing of cooling, cooling methods, target temperature, duration, and rewarming rate. The primary endpoint was a favorable neurological outcome at hospital discharge.
Results: Of the 452 unconscious adult patients treated with therapeutic hypothermia, 435 who were cooled to 32 °C to 34 °C were included; 94 were non-VF arrest (non-VF group) and 341 were VF arrest (VF group). The non-VF group had a lower frequency of favorable neurological outcome than the VF group (27.7% vs. 63.7%, p<0.0001). However, in the subgroups of patients who were divided into quartiles on the basis of collapse-to-ROSC interval, the non-VF group had a similar frequency of favorable neurological outcome than the VF group among patients with the quartile-1 interval (92 % vs. 89 %, p=0.75). The non-VF group had lower frequencies of favorable neurological outcome than the VF group among patients with each quartile-2, quartile-3 and quartile-4 interval. In a multiple logistic-regression analysis among patients with the interval of quartile-1, non-VF arrest was not an independent predictor of a favorable neurological outcome with adjusted odds ratios of 0.53 (95% CI, 0.06–4.70, p=0.56). The area under the ROC curve in the non-VF group was 0.82, and a cut off value of the collapse-to-ROSC interval for identification of a favorable neurological outcome was 25 minutes. A frequency of favorable neurological outcome was 58 % in non-VF patients who achieved ROSC within 25 minutes after cardiac arrest.
Conclusion: Therapeutic hypothermia for non-VF patients has neurological benefits when the ROSC was achieved within 25 minutes after cardiac arrest.
- © 2010 by American Heart Association, Inc.