Abstract 48: Effect of Therapeutic Hypothermia on Survival and Neurological Outcome in the Elderly
Background: Therapeutic hypothermia (TH) improves outcomes from out-of-hospital cardiac arrest (OOHCA), but requires significant resources. Protocols for TH have not been standardized such that the application of this treatment remains highly varied and is often left to the judgment of the treating physician. Older age is considered a negative prognostic factor after OOHCA. The purpose of this study was to assess the benefit of TH on survival and neurologic outcome particular to the elderly population.
Methods: This is a retrospective cohort study of data reported to a single registry of patients treated for OOHCA in a regional cardiac care system serving a population of approximately 10 million. Patients with return of spontaneous circulation (ROSC) are directed to designated cardiac receiving centers with established TH protocols. The decision to initiate or withhold TH is determined by the treating physician. All patients 65 years or older were identified from the registry over a 2-year period. Patients were excluded from the regression analysis if awake and responsive in the ED, died prior to hospital admission, or had pre-existing coma. The adjusted odds ratio for survival with good neurologic outcome (defined as cerebral perfusion category (CPC) 1 or 2) was calculated for patients who received TH compared to a reference group without TH.
Results: There were 1612 patients, of whom 552 (34%) received TH. The median age was 78 (IQR 71-85); 56% were male. In the cohort, 493 (31%) patients survived to hospital discharge with 266 (17%) patients surviving with CPC of 1 or 2. Of the 1292 patients considered for TH, 192 (25%) of the 552 patients who received TH survived to hospital discharge and 97 (18%) survived with good neurologic outcome, compared to 150 (20%) and 57 (8%) respectively in the group without TH. The adjusted odds ratio for survival with good neurologic outcome in patients who received TH was 2.0 (95%CI 1.3, 3.0) adjusted for age, initial rhythm, witness, bystander CPR, and treatment hospital.
Conclusion: Therapeutic hypothermia is associated with improved neurologic outcome in the elderly population.
Author Disclosures: N. Bosson: None. A.H. Kaji: None. W. Koenig: None. J.T. Niemann: None.
- © 2014 by American Heart Association, Inc.