Abstract 316: Therapeutic Hypothermia for Comatose Survivors After Out-of-Hospital Nonshockable Cardiac Arrest
Clinical evidence strongly supports therapeutic hypothermia for unconscious adult patients with return of spontaneous circulation (ROSC) after out-of-hospital shockable cardiac arrest (VF or pulseless VT), but there are insufficient data that therapeutic hypothermia had neurological benefit for those after non-shockable cardiac arrest (PEA or asystole).
We conducted a multicenter registry of therapeutic hypothermia (J-PULSE-HYPO study) for unconscious adult patients with ROSC after out-of-hospital cardiac arrest due to cardiac etiology from 14 institutions. At the same periods, All-Japan Utstein Registry, a prospective, nationwide, population-based registry of out-of-hospital cardiac arrest was established by the Fire and Disaster Management Agency. From the data of the two registries, we extracted the eligible patients with ROSC after bystander-witnessed non-shockable cardiac arrest; the intervention group consisting of patients who treated with post-ROSC cooling (32-34°C for 12-72 hours), and the control group consisting of patients who met the inclusion criteria of the J-PULSE-HYPO study and matched with the baseline characteristics of the intervention group. The primary endpoint was a 30-day favorable neurological outcome after cardiac arrest.
Between 2005 and 2009, 65 of the 452 comatose adult patients treated with post-ROSC cooling were eligible as the intervention group. In the intervention group, the time interval from collapse to ROSC ranged from 5 to 50 minutes, with a mean (± SD) of 27.2 ±11.1 minutes, a median of 27 minutes, and 25th and 75th percentile values of 19.75 and 33.25 minutes, respectively. Of the 4,037 patients with ROSC after bystander-witnessed non-shockable cardiac arrest due to cardiac etiology, 634 were matched as control group. Frequency of a 30-day favorable neurological outcome was a significantly higher in the intervention group than in the control group (37% vs.18%, p=0.0004). The adjusted odds ratio for favorable neurological outcome after the intervention group was 2.9 (95% CI, 1.5 to 5.6).
Therapeutic hypothermia improved neurological outcome for unconscious adult patients with ROSC after out-of-hospital non-shockable cardiac arrest.>
- © 2012 by American Heart Association, Inc.