Abstract 101: Optimal Candidates for Therapeutic Hypothermia with Return of Spontaneous Circulation After Out-of-Hospital Cardiac Arrest
BACKGROUND Therapeutic hypothermia for comatose adult patients after cardiac arrest has demonstrated neurological benefits. In the AHA /ReSS 2010, we demonstrated that higher ammonia levels were associated with poor neurological outcomes.Losert et al showed that higher glucose levels increased poor neurological outcomes We hypothesized that both levels of ammonia and glucose would be associated with neurological outcomes for therapeutic hypothermia.
METHODS We conducted a multicenter observational study of therapeutic hypothermia for unconscious adult patients with return of spontaneous circulation (ROSC) after out-of-hospital cardiac arrest. The primary endpoint was favorable neurological outcome at hospital discharge.
RESULTS Of the 376 unconscious adult patients who were treated with therapeutic hypothermia (32 °C to 34 °C) after ROSC, 119 whose ammonia and glucose levels were measured on hospital arrival were included. The patients were divided into 4 groups based on whether their ammonia and glucose levels fell above and below the median levels of ammonia of 79.5μg/dl and glucose of 255μg/dl. Significant difference was seen in favorable neurological outcome among the 4 groups (p=0.002). Favorable neurological outcome was 100% in group 1 among patients with ROSC after non-shockable cardiac arrest. In a logistic-regression model in which we adjusted for other independent predictors, those 4 groups remained associated with neurological outcomes.
CONCLUSION In patients treated with therapeutic hypothermia, blood ammonia and glucose levels were associated with neurological outcomes. The optimal candidates for the treatment of therapeutic hypothermia were unconscious adult patients with ammonia levels of ≤79.5μg/dl and glucose levels of ≤255μg/dl on hospital arrival.
- © 2011 by American Heart Association, Inc.