Advertisement

Mild therapeutic hypothermia is associated with favourable outcome in patients after cardiac arrest with non-shockable rhythms

      Abstract

      Aim

      Mild therapeutic hypothermia (32–34 °C) improves neurological recovery and reduces the risk of death in comatose survivors of cardiac arrest when the initial rhythm is ventricular fibrillation or pulseless ventricular tachycardia. The aim of the presented study was to investigate the effect of mild therapeutic hypothermia (32–34 °C for 24 h) on neurological outcome and mortality in patients who had been successfully resuscitated from non-ventricular fibrillation cardiac arrest.

      Methods

      In this retrospective cohort study we included cardiac arrest survivors of 18 years of age or older suffering a witnessed out-of-hospital cardiac arrest with asystole or pulseless electric activity as the first documented rhythm. Data were collected from 1992 to 2009. Main outcome measures were neurological outcome within six month and mortality after six months.

      Results

      Three hundred and seventy-four patients were analysed. Hypothermia was induced in 135 patients. Patients who were treated with mild therapeutic hypothermia were more likely to have good neurological outcomes in comparison to patients who were not treated with hypothermia with an odds ratio of 1.84 (95% confidence interval: 1.08–3.13). In addition, the rate of mortality was significantly lower in the hypothermia group (odds ratio: 0.56; 95% confidence interval: 0.34–0.93).

      Conclusion

      Treatment with mild therapeutic hypothermia at a temperature of 32–34 °C for 24 h is associated with improved neurological outcome and a reduced risk of death following out-of-hospital cardiac arrest with non-shockable rhythms.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Resuscitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Atwood C.
        • Eisenberg M.S.
        • Herlitz J.
        • Rea T.D.
        Incidence of EMS-treated out-of-hospital cardiac arrest in Europe.
        Resuscitation. 2005; 67: 75-80
        • Chugh S.S.
        • Jui J.
        • Gunson K.
        • et al.
        Current burden of sudden cardiac death: multiple source surveillance versus retrospective death certificate-based review in a large U.S. community.
        J Am Coll Cardiol. 2004; 44: 1268-1275
        • de Vreede-Swagemakers J.J.
        • Gorgels A.P.
        • Dubois-Arbouw W.I.
        • et al.
        Out-of-hospital cardiac arrest in the 1990's: a population-based study in the Maastricht area on incidence, characteristics and survival.
        J Am Coll Cardiol. 1997; 30: 1500-1505
        • Cobb L.A.
        • Fahrenbruch C.E.
        • Olsufka M.
        • Copass M.K.
        Changing incidence of out-of-hospital ventricular fibrillation, 1980–2000.
        JAMA. 2002; 288: 3008-3013
        • Hypothermia after Cardiac Arrest Study Group
        Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest.
        N Engl J Med. 2002; 346: 549-556
        • Bernard S.A.
        • Gray T.W.
        • Buist M.D.
        • et al.
        Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia.
        N Engl J Med. 2002; 346: 557-563
        • Hess E.P.
        • Campbell R.L.
        • White R.D.
        Epidemiology, trends, and outcome of out-of-hospital cardiac arrest of non-cardiac origin.
        Resuscitation. 2007; 72: 200-206
        • Herlitz J.
        • Engdahl J.
        • Svensson L.
        • Young M.
        • Angquist K.A.
        • Holmberg S.
        Decrease in the occurrence of ventricular fibrillation as the initially observed arrhythmia after out-of-hospital cardiac arrest during 11 years in Sweden.
        Resuscitation. 2004; 60: 283-290
        • Rea T.D.
        • Eisenberg M.S.
        • Sinibaldi G.
        • White R.D.
        Incidence of EMS-treated out-of-hospital cardiac arrest in the United States.
        Resuscitation. 2004; 63: 17-24
        • Hachimi-Idrissi S.
        • Corne L.
        • Ebinger G.
        • Michotte Y.
        • Huyghens L.
        Mild hypothermia induced by a helmet device: a clinical feasibility study.
        Resuscitation. 2001; 51: 275-281
        • Oddo M.
        • Schaller M.D.
        • Feihl F.
        • Ribordy V.
        • Liaudet L.
        From evidence to clinical practice: effective implementation of therapeutic hypothermia to improve patient outcome after cardiac arrest.
        Crit Care Med. 2006; 34: 1865-1873
        • Arrich J.
        European Resuscitation Council Hypothermia After Cardiac Arrest Registry Study Group. Clinical application of mild therapeutic hypothermia after cardiac arrest.
        Crit Care Med. 2007; 35: 1041-1047
        • Jacobs I.
        • Nadkarni V.
        • Bahr J.
        • et al.
        Cardiac arrest and cardiopulmonary resuscitation outcome reports: update and simplification of the Utstein templates for resuscitation registries. A statement for healthcare professionals from a task force of the international liaison committee on resuscitation (American Heart Association, European Resuscitation Council, Australian Resuscitation Council, New Zealand Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa).
        Resuscitation. 2004; 63: 233-249
        • Jennett B.
        • Bond M.
        Assessment of outcome after severe brain damage.
        Lancet. 1975; 1: 480-484
        • Brain Resuscitation Clinical Trial II Study Group
        A randomized clinical study of a calcium-entry blocker (lidoflazine) in the treatment of comatose survivors of cardiac arrest.
        N Engl J Med. 1991; 324: 1225-1231
        • Safar P.
        • Bircher N.G.
        Cardiopulmonary cerebral resuscitation: basic and advanced cardiac and trauma life support: an introduction to resuscitation medicine.
        3rd ed. W.B. Saunders, London1988 (p. 267)
        • Zeiner A.
        • Holzer M.
        • Sterz F.
        • et al.
        Hyperthermia after cardiac arrest is associated with an unfavorable neurologic outcome.
        Arch Intern Med. 2001; 161: 2007-2012
        • Holzer M.
        • Müllner M.
        • Sterz F.
        • et al.
        Efficacy and safety of endovascular cooling after cardiac arrest: cohort study and Bayesian approach.
        Stroke. 2006; 37: 1792-1797
        • Arrich J.
        • Holzer M.
        • Herkner H.
        • Müllner M.
        Hypothermia for neuroprotection in adults after cardiopulmonary resuscitation.
        Cochrane Database Syst Rev. 2009; 4: CD004128
        • Kim F.
        • Olsufka M.
        • Longstreth Jr, W.T.
        • et al.
        Pilot randomized clinical trial of prehospital induction of mild hypothermia in out-of-hospital cardiac arrest patients with a rapid infusion of 4 degrees C normal saline.
        Circulation. 2007; 115: 3064-3070
        • Nolan J.P.
        • Deakin C.D.
        • Soar J.
        • Böttiger B.W.
        • Smith G.
        European Resuscitation Council. European Resuscitation Council guidelines for resuscitation 2010. Section 4. Adult advanced life support.
        Resuscitation. 2010; 81: 1305-1352
        • Morrison L.J.
        • Deakin C.D.
        • Morley P.T.
        • et al.
        Part 8: Advanced life support: 2010 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations.
        Circulation. 2010; 122: 345-421
        • Dumas F.
        • Grimaldi D.
        • Zuber B.
        • et al.
        Is hypothermia after cardiac arrest effective in both shockable and non-shockable patients? Insight from a large registry.
        Circulation. 2011; 123: 877-886
        • Eberspächer E.
        • Werner C.
        • Engelhard K.
        • et al.
        Long-term effects of hypothermia on neuronal cell death and the concentration of apoptotic proteins after incomplete cerebral ischemia and reperfusion in rats.
        Acta Anaesthesiol Scand. 2005; 49: 477-487
        • Shibano T.
        • Morimoto Y.
        • Kemmotsu O.
        • Shikama H.
        • Hisano K.
        • Hua Y.
        Effects of mild and moderate hypothermia on apoptosis in neuronal PC12 cells.
        Br J Anaesth. 2002; 89: 301-305
        • Xu L.
        • Yenari M.A.
        • Steinberg G.K.
        • Giffard R.G.
        Mild hypothermia reduces apoptosis of mouse neurons in vitro early in the cascade.
        J Cereb Blood Flow Metab. 2002; 22: 21-28