Abstract 158: Incidence, Etiology and Implications of Shock in Therapeutic Hypothermia
Background: Therapeutic hypothermia improves neurologic outcome in patients surviving resuscitation after cardiac arrest. However, little has been reported on the incidence and impact of shock on these patients. We sought to identify the incidence and etiology of shock and its implications on mortality and favorable neurologic status.
Methods: Two hundred six consecutive patients underwent therapeutic hypothermia after cardiac arrest at ANW from January 2006 through December 2010. For these patients, incidence of shock was determined during both cooling and rewarming phases of therapeutic hypothermia. For each case, shock was further classified by type - cardiogenic, distributive, hypovolemic, obstructive, mixed or unknown.
Results: The incidence of shock during cooling was 74.8% and during warming was 78.0%. The most common etiology of shock during cooling was cardiogenic (46.1%). Despite extensive review, a large number of patients did not meet any specific criteria for etiology during rewarming and remained as unknown (40.9%). There were no significant associations between shock during cooling and survival (P= 0.20) or favorable neurologic score at discharge/follow-up (P=0.38, P=0.99). There were no significant associations between shock during rewarming and survival (P=0.11) or favorable neurologic score at discharge/follow-up (P=0.055, P=0.9). Of the patient scenario factors considered, younger age (P=0.02, P=0.008), performance of an angiogram (P=0.001, P=0.0002), shorter time to ROSC (P<0.02), and initial rhythm of VT/VF (P=0.0008, P=0.002) were associated with survival and favorable neurologic outcome at discharge.
Conclusions: The incidence of shock in patients undergoing therapeutic hypothermia is high. There were no statistical associations between shock during cooling or rewarming and survival or neurologic score. Younger age, performance of an angiogram, shorter time to ROSC, and initial rhythm of VT/VF were all associated with survival and improved neurologic outcome.
- © 2012 by American Heart Association, Inc.