Abstract 68: Trends in Postresuscitation Care: A 7-Year Experience After Implementation of Therapeutic Hypothermia
Background: The 2010 AHA guidelines for CPR emphasize the crucial importance of patient care in the early post-resuscitation period. In particular, therapeutic hypothermia and adequate treatment of the post-cardiac arrest syndrome are of utmost importance.
Methods: In a single center retrospective registry analysis, the data from all resuscitated patients treated in the cardiology ICU between 2003 and 2009 were evaluated systematically. All data on hemodynamics, respiration, hypothermia, diagnostic and therapeutic procedures and outcome were analyzed.
Results: 436 consecutive post-cardiac arrest patients were included. The proportion of patients treated with mild hypothermia could be increased from 56% (2003) to >80% (2006-2009). >90% of the patients with out-of-hospital arrest (OHA) were cooled. Induction of therapeutic hypothermia could be accelerated significantly (time to <34°C, 2003: 13h 59min, 2005: 6h 30min, 2009: 2:15min). The frequency of using cold infusions and intravascular cooling devices correlated directly with the velocity of cooling induction. The PaO2/FiO2 ratio on arrival at the ICU was 242±23 indicating an acute lung injury (ALI). The comparison of cooled and uncooled patients showed no significant differences in the parameters of respiration (in spite of significantly greater fluid intake in the hypothermia group). However, the cooled patients were significantly longer intubated than the uncooled patients (7.0±0.9 vs. 3.7±1.5 days). In patients treated with hypothermia the LVEF improved significantly from 35.4±0.7% at admission to 40.1±1.1% at hospital discharge. In contrast, in patients not treated with hypothermia there was no significant increase in LVEF. In-hospital mortality was 43%. Despite improvement in cooling measures, there was no significant improvement in the survival rates between 2003 and 2009.
Conclusion: This registry provides an overview of trends in post-cardiac arrest treatment. By optimizing the post-resuscitation care cooling induction can be accelerated. An acute lung injury is part of the post cardiac arrest syndrome. Hypothermia might improve LVEF recovery in patients with post cardiac arrest syndrome.
- Cardiopulmonary resuscitation
- Acute heart failure
- Post cardiac arrest care
- Post cardiac resuscitation
- © 2011 by American Heart Association, Inc.