Abstract 286: Efficacy of Surface-versus Invasive Cooling After Sudden Cardiac Arrest
Purpose: Mild induced hypothermia (MIH) has been shown to improve both survival and neurological outcome in comatose sudden cardiac arrest (SCA)-survivors. MIH has to be applied very early to be effective. Surface cooling methods seem to be inferior to invasive ones regarding cooling efficacy. In this study we compared both cooling methods for temperature management, hypothermia-associated complications and outcome in SCA-survivors.
Methods: In total, 179 adult ICU patients with an indication for MIH were prospectively enrolled between May 2006 and August 2009. Hypothermia was induced with either invasive or non-invasive cooling. Core body temperature was operated at 33.0°C over a period of 24 hours. Temperature decline and maintenance as well as cooling-associated complications were measured. Neurological status was evaluated at hospital discharge using the Pittsburgh Cerebral Performance Category (CPC).
Results: One hundred twenty-one patients were cooled with invasive (119 Coolgard, 2 ECMO) and 58 patients with non-invasive cooling-systems (52 ArcticSun, 3 Theramed, 2 EmCools, 1 Blanketrol). Besides more acute myocardial infarctions, history of diabetes, higher vasopressor medication and lower body mass index in the invasive cooling group, there were no major differences in baseline characteristics between both groups. Time from SCA to target temperature did not differ in both groups (513 min (IQR 405) in the non-invasive, 485 min (IQR 324) in the invasive group, p=n.s.). Target temperature of 33.0°C was maintained more stable in the invasive cooling-group (33.0 (IQR 0.1) vs. 32.7°C (IQR 0.5), p<0.0001). MIH-improved neurological and clinical outcome was equal in both groups. Bleeding complications were more often associated with invasive cooling (p=0.018). Use of blood-or factor-concentrates did not differ. No differences were seen in the incidence of infection, arrhythmia or renal insufficiency.
Conclusions: External and invasive cooling did not result in different outcome. Temperature management with invasive cooling was more feasible. Bleeding complications were accentuated by invasive cooling, but did not especially occur at catheter access-sites.
- © 2010 by American Heart Association, Inc.