Abstract 314: Outcomes of Patients with Cardiac Arrest Treated with Therapeutic Hypothermia: Insights on Etiology and Initial Rhythm
Therapeutic hypothermia (TH) improves neurological outcomes and reduces mortality in patients successfully resuscitated after VT/VF cardiac arrest (CA). Outcomes according to the clinical scenarios leading to the CA and initial rhythm, though, vary significantly.
We report a single center experience that recommended TH for all patients who were comatose after CA, regardless of etiology or initial rhythm. Patients were categorized according to clinical scenario surrounding CA and initial rhythm. Good neurologic recovery was defined as a cerebral performance category of 1/2 (no deficit to moderate disability). All outcomes were assessed at discharge.
A total of 135 patients with CA received TH of whom 79 cases (58%) had cardiac etiology (27 [20%] were STEMI and 52 [39%] other cardiac etiologies) and 56 (42%) non-cardiac. Patients with a cardiac cause of CA were more likely to survive until discharge than non-cardiac (51% vs. 23%, p=0.002) and have better neurologic recovery (41% vs. 8%, p<0.001). VT/VF was the most common initial rhythm (50%), followed by PEA (30%), asystole (19%), and bradycardia (2%). Patients presenting with VT/VF were most likely to survive at discharge and have better neurologic recovery compared to non-shockable rhythms (p<0.001 for both). (Figure)
Cardiac etiologies, in particular VT/VF, were the most common cause of CA in patients undergoing TH. PTs with VT/VF had the best survival and neurologic outcomes. Further research into the optimal treatment of CA from non-cardiac etiology or non-shockable rhythms is needed.
- © 2012 by American Heart Association, Inc.