Abstract 13218: Adverse Effects and Incidence of Post-Rewarming Pyrexia in Patients Treated With Therapeutic Hypothermia After Cardiac Arrest
Background: Therapeutic hypothermia (TH) has been shown to improve clinical outcomes in patients resuscitated from cardiac arrest. The adverse effect profile of TH, including rebound pyrexia early after rewarming and discontinuation of cooling, is poorly described in the literature.
Objective: To characterize adverse effects and incidence of post-rewarming pyrexia in a multicenter US registry of post-arrest patients treated with TH.
Methods: We performed a retrospective chart review of patients experiencing cardiac arrest at four hospitals participating in an internet-based US registry specifically designed to examine post-arrest TH care. Analysis and chi-squared testing was performed using statistical software.
Results: Of the 440 cardiac arrest patients evaluated between 5/2005 and 5/2011, 206/440 (46%) had return of spontaneous circulation; 125/206 (61%) of these resuscitated patients were treated with TH. In this TH-treated cohort, mean age was 59± 16 yrs; 57/125 (46%) were female and 32/125 (26%) had VF/VT as an initial rhythm. Mean cooling duration was 23.3± 8.4 hrs and mean rewarming time was 12.9± 6.1 hrs. Survival to discharge for TH-treated patients was 51/125 (41%), with 32/51 (63%) of these exhibiting good neurologic outcome. With regard to adverse effect profile within 72 hours of arrest, shivering was noted in 18/125 (14%) patients, skin breakdown in 8/125 (6%), clinically-evident bleeding in 4/125 (3%) and arrhythmia in 6/125 (5%). Seizures were detected in 20/125 (16%) patients. Post-rewarming pyrexia within 24 hrs occurred in 30/125 (24%) with a mean temperature maximum of 38.8±0.4 oC. Of note, pyrexia of 39.0 oC or greater occurred in 9/30 (30%) of these patients. Good neurologic outcome at discharge was more common in patients who did not experience early pyrexia (74% vs. 53%, p=0.052).
Conclusions: In a large multicenter cohort of TH-treated post-arrest patients, bleeding and seizure activity occurred at similar frequencies to prior published reports. Of concern, post-rewarming pyrexia was common and pronounced. This has important implications for post-arrest care protocol development, as early pyrexia may be injurious to neurologic recovery.
- © 2011 by American Heart Association, Inc.