Abstract 339: Combining Urgent Coronary Angiography With Therapeutic Hypothermia Does Not Slow Cooling Times for Comatose Survivors of Cardiac Arrest
Introduction: Selected comatose survivors of out-of-hospital-cardiac arrest (OHCA) meet criteria for both emergent percutaneous coronary intervention (PCI) and induction of mild therapeutic hypothermia (MTH). It is unclear which should be performed first. We hypothesized that urgent catheterization prior to MTH may significantly prolong time to cooling.
Methods: We conducted a retrospective cohort study, reviewing electronic medical records of all patients treated with MTH in the University of Michigan Emergency Department (ED) for OHCA. We identified whether the endovascular cooling device was inserted in the ED or catheterization lab and assessed time from ED arrival to cooling device insertion, to cooling initiation, and to reaching ≤33.5°C. Neurological outcomes were determined by Cerebral Performance Category (CPC) via chart review. Times were compared via Student’s t-tests.
Results: Between 7/1/2006 and 9/14/2012, 123 consecutive patients were treated with MTH. Twenty-six (22%) had their device placed in the catheterization lab (14/26 received PCI) while 92 (77%) had theirs placed in the ED. There was no significant difference between catheterization lab v. ED device placement in time from ED arrival to device insertion, arrival to cooling initiation, and arrival to reaching target temperature (see table). Forty-six percent vs 39% of those whose devices were inserted in the catheterization lab vs ED survived past hospital discharge (OR 1.8; 95% CI 0.7-4.4), and 35% vs 39% had favorable 6-month neurological outcomes (OR 1.3; 95% CI 0.5-3.3).
Conclusions: In our system, initiating cooling in the catheterization lab as opposed to the ED does not significantly delay cooling times. The resources and efficiencies involved in activation of the cath lab team may offset the time taken to perform angiography and potential subsequent PCI. These data support the practice of immediate cardiac catheterization in appropriate comatose survivors of cardiac arrest.
- © 2013 by American Heart Association, Inc.