Abstract 229: Outcome of Mild therapeutic Hypothermia in Out-of-Hospital Cardiac Arrest: A Nationwide Retrospective Analysis
Background: MTH has been known to be effective in patients with shorckable rhythm but controversial whether it improves outcomes in patients with non-shockable rhythms or not. This study aimed to determine whether MTH was associated with improved out-of-hospital cardiac arrest (OHCA) outcomes by ECG rhythms.
Methods: We used a nationwide OHCA cohort data from 2008 to 2010. We included OHCA survivors of presumed cardiac etiology with age more than 15 years-old, excluding patients with unknown outcome or alert mental status after prehospital return of spontaneous circulation. MTH group was defined as patients received any method of hypothermia. The primary and secondary outcomes were survival to hospital discharge and good neurological recovery. Multivariable logistic regression analysis was used to compare outcome of MTH and non-MTH group in total cohort and propensity-score matched cohort including subgroup analysis by ECG type.
Results: Among 64,155 OHCA patients, 4,557 with survived to admission were used for analysis (1,599 survived to discharge and 499 discharged with good neurological recovery). Overall, MTH group had better outcome than non-MTH group in survival to discharge (53.6% vs. 33.4%, p<0.001) and good neurological outcome (18.3% vs. 10.3%, p<0.001). In the total cohort, the adjusted ORs of MTH group compared to non-MTH group were 1.81 (95%CI 1.44-2.29) for survival to discharge and 1.37 (95%CI 1.00-1.89) for good neurological outcome. In the propensity score-matched cohort, adjusted ORs of MTH group compared to non-MTH group were 1.83(95%CI 1.33-2.50) for survival to discharge and 1.20 (95%CI 0.76-1.88) for good neurological outcome. In the subgroup analysis, the adjusted ORs of MTH group compared to non-MTH group for survival to discharge were 2.04(95%CI 1.15-3.62) in shockable rhythm and 2.05 (95%CI 1.51-2.79) in non-shockable rhythm. Adjusted ORs of MTH group to non-MTH group for good neurological recovery were 1.86(95% CI 1.07-3.21) in shockable rhythm and 1.13 (95% CI 0.59-2.20) in non-shockable rhythm.
Conclusions: MTH was associated with improved survival to discharge but not good neurological. In a subgroup of shockable rhythm, MTH was associated with better neurological outcome and survival to discharge.
- © 2013 by American Heart Association, Inc.