Abstract 10614: Therapeutic Hypothermia: Delay in Reaching Target Temperature Diminishes the Odds of Good Cerebral Performance Post-Cardiac Arrest
Introduction: Initiation of therapeutic hypothermia (TH) post-cardiac arrest has dramatically improved survival. Among survivors, however, anoxic neurologic injury remains an important cause of subsequent mortality and morbidity. There is variability of current TH practice in time to cooling, time to target temperature, and duration of cooling. Thus, we assessed differences in neurologic outcome by time to initiation, time to target temperature, and duration of TH.
Methods: We used hospital-specific data from the International Cardiac Arrest Registry (INTCAR) for 172 adult patients with an out-of-hospital cardiac arrest in one Midwestern state. The outcome of interest was Cerebral Performance Category (CPC) classified as good (CPC=1), moderate (CPC=2) or poor (CPC=3-5) neurological outcome. CPC was assessed at transfer from ICU, discharge from hospital, and post discharge follow-up. Multinomial logistic regression models were used to estimate the odds of having a moderate or poor outcome compared with a good outcome at each time.
Results: Average age was 63.6 years and 74% of subjects were male. For every 5 minute delay in initiating TH treatment, there were significantly increased odds of a poor neurological outcome compared to a good outcome at transfer from ICU (OR=1.04, 95% C.I.=1.01-1.07). Results were similar for hospital discharge and post-discharge follow-up. Moreover, for each 30 minutes from arrest to reaching target temperature, there were significantly increased odds of poor versus good outcome at hospital discharge (OR=1.11,95% C.I. 1.00-1.22) and at post-discharge follow-up (OR=1.18,95% C.I. 1.04-1.34). No significant findings were detected for duration of TH.
Conclusion: In adults undergoing TH post cardiac arrest, delay in initiation of TH and reaching target temperature differentiated poor versus good neurologic outcomes. Randomized trials assessing the range of current recommended guidelines for TH should be conducted to establish optimal treatment protocols.
- © 2011 by American Heart Association, Inc.