Abstract 325: Early Initiation and Fast Achievement of Mild Therapeutic Hypothermia in Patients Successfully Resuscitated from Out-of-Hospital Cardiac Arrest
AIM: We hypothesized that a protocol with an early initiation of cooling as well as an earlier achievement of target temperature would be associated with a pronounced beneficial effect as compared to a delayed slow induction of mild therapeutic hypothermia (MTH) in patients after cardiac arrest.
MATERIALS AND METHODS: This was a retrospective study in patients successfully resuscitated from witnessed out-of-hospital cardiac arrest with shockable cardiac rhythm. All patients were treated with MTH (32.0°C to 34.0°C) for 24 hours. For the intervention group we selected patients from our cardiac-arrest registry receiving MTH by the application of cooling pads (EMCOOLSpad, EMCOOLS AG, Austria), with or without the additive administration of cold saline. Patients from cooling-group of the “Hypothermia after Cardiac Arrest (HACA) Trial” receiving surface cooling with cold air (TheraKool, Kinetic Concepts Inc., United Kingdom) served as control group. Primary outcome measure was best neurologic function within six month with a cerebral performance category score of 1 or 2 defining good neurologic recovery.
RESULTS: From 1996 to 2011 97 patients (51%) were treated with an early and fast cooling regimen. A total of 92 patients (49%) from the HACA-Trial served as controls. In the intervention group cooling was initiated 50 minutes after return of spontaneous circulation (IQR 19-75) as compared to 126 minutes (IQR 67-199) in the control group (p<0.01). The time from cooling start to a temperature below 34.0°C was significantly shorter in the intervention group (93 minutes (IQR 57-155) vs. 360 minutes (IQR 240-720); p<0.01). In the intervention group 72 patients (74%) had favourable neurological outcome as compared to 56 patients (61%) in the control group (adjusted risk ratio 1.45; 95% confidence interval: 1.21-1.73).
CONCLUSION: In this retrospective study early initiation and fast achievement of MTH was associated with better neurologic outcome in patients after cardiac arrest.
- Therapeutic hypothermia
- Cardiac arrest
- Return of spontaneous circulation (ROSC)
- Cardiopulmonary resuscitation
Author Disclosures: C. Testori: None. P. Stratil: None. H. Losert: None. H. Herkner: None. M. Holzer: None. A. Schober: None. C. Wallmüller: None. F. Sterz: None.
- © 2014 by American Heart Association, Inc.