Abstract 11119: Safety and Effectiveness of Cardiac Catheterization Within 24 Hours of Admission in Cardiac Arrest Patients Treated With Mild Therapeutic Hypothermia
Introduction: The use of mild therapeutic hypothermia (MTH) post-cardiac arrest is increasing; however, there is reluctance to combine early cardiac catheterization with MTH.
Hypothesis: This study investigated the impact of early cardiac catheterization on outcomes of patients treated with MTH.
Methods: A cohort of 180 consecutive patients with resuscitated cardiac arrest treated by standardized MTH protocol at a tertiary care center from January 2008 to May 2011 was analyzed. Patients who had cardiac catheterization with MTH within 24 hours of admission (MTH+cath) were compared to those who had MTH without early cardiac catheterization (MTH-only).
Results: There were 74 patients in the MTH+cath group vs. 106 in the MTH-only group. Patients in the MTH+cath group were more likely to present with ventricular tachycardia/fibrillation (VT/VF) (81% vs. 50%, p<0.0001); no baseline differences for age, location of arrest, witnessed arrest, bystander CPR, cooling techniques and time from collapse to target temperature were noted between the groups. Compared to the MTH-only group, the MTH+cath group had significantly reduced in-hospital mortality (48.6% vs. 73.6%, p=0.014) and 1-year mortality (55.4% vs. 85.6%, p<0.0001) and was more likely to be functionally recovered enough to go home at discharge (35.1% vs. 8.5%, p<0.0001) and still be home at 1-year follow-up (35.4% vs. 8.2%, p<0.0001). There were no differences in rates of dysrhythmias, transfusions, duration of intubation or length of critical care stay between the two groups. Early cardiac catheterization was most beneficial when the arrest rhythm was VT/VF (Table).
Conclusion: Cardiac catheterization within 24 hours of initiation of mild therapeutic hypothermia post-cardiac arrest is safe and associated with improved survival and functional recovery, especially when the presenting rhythm is VT/VF.
- © 2012 by American Heart Association, Inc.