Abstract 18128: Efficacy and Safety of Slight Therapeutic Hypothermia (35 °C) for Post Cardiac Arrest Syndrome due to Ventricular Fibrillation with Low Left Cardiac Function
Backgrounds & Objective: Mild therapeutic hypothermia (32-34°C, 24-48 hours: mild TH) for post cardiac arrest syndrome (PCAS) due to ventricular fibrillation (VF) has been strongly recommended in the American Heart Association (AHA) Guidelines 2010 (class I). But it is still unclear what temperature is best for low cardiac function patients including acute coronary syndrome (ACS) cases. In real world, executing mild TH for patients with severe left ventricular dysfunction is not so easy and safe because of hypotension, arrhythmias and unstable vital signs. Then we studied whether slight therapeutic hypothermia (35 °C: Slight TH) was effective and safe compare with mild TH for PCAS due to VF.
Methods: Consecutive PCAS patients who were witnessed, confirmed VF caused by cardiac or coronary events and introduced therapeutic hypothermia for the latest 57 months were sorted into the GroupM (Mild TH, 34°C, 24-48 hours) and the GroupS (Slight TH, 35 °C, 24-48 hours).The primary end point was a favorable neurological outcome (cerebral performance category: CPC 1 or 2) in 30th days after cardiac arrest. Secondary end points were the changes of cardiac index (CI) after introducing therapeutic hypothermia, the time required to reach target temperature and the rate of complications (infections, bleeding, arrhythmias etc.) within fourteen days.
Results: Thirty-three patients (sixteen ACS cases) were studied (GroupM 17 patients and GroupS 16 patients). The rate of favorable neurological outcome was available and did not differ significantly between the two groups (59% vs. 69%, p=0.57). The time to reach target temperature was significantly shorter in the GroupS (4.8h vs. 1.6h, p<0.01). The decrease of CI was remarkable in the groupM (before TH/during TH, GroupM 2.8/2.0, GroupS 2.1/2.2, the changes of them were Δ40% vs. +0.05%, p<0.01). The rate of complications did not differ significantly between them and there were no major complications.
Conclusions: Slight therapeutic hypothermia for PCAS due to VF with low left ventricular function is effective and safe possibility.
- © 2012 by American Heart Association, Inc.