Abstract
Aim
To assess differences in cerebral performance category (CPC) in patients who received
therapeutic hypothermia post cardiac arrest by time to initiation, time to target
temperature, and duration of therapeutic hypothermia (TH).
Methods
A secondary data analysis was conducted using hospital-specific data from the international
cardiac arrest registry (INTCAR) database. The analytic sample included 172 adult
patients who experienced an out-of-hospital cardiac arrest and were treated in one
Midwestern hospital. Measures included time from arrest to ROSC, arrest to TH, arrest
to target temperature, and length of time target temperature was maintained. CPC was
assessed at three points: transfer from ICU, discharge from hospital, and post discharge
follow-up.
Results
Average age was 63.6 years and 74.4% of subjects were male. Subjects had TH initiation
a mean of 94.4 min (SD 81.6) after cardiac arrest and reached target temperature after 309.0 min (SD 151.0). In adjusted models, the odds of a poor neurological outcome increased with
each 5 min delay in initiating TH at transfer from ICU (OR = 1.06, 95% C.I. 1.02–1.10). Similar results were seen for neurological outcomes at
hospital discharge (OR = 1.06, 95% C.I. 1.02–1.11) and post-discharge follow-up (OR = 1.08, 95% C.I. 1.03–1.13). Additionally the odds of a poor neurological outcome increased
for every 30 min delay in time to target temperature at post-discharge follow-up (OR = 1.17, 95% C.I. 1.01–1.36).
Conclusion
In adults undergoing TH post cardiac arrest, delay in initiation of TH and reaching
target temperature differentiated poor versus good neurologic outcomes. Randomized
trials assessing the range of current recommended guidelines for TH should be conducted
to establish optimal treatment protocols.
Keywords
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Article info
Publication history
Published online: January 09, 2012
Accepted:
December 7,
2011
Received in revised form:
November 29,
2011
Received:
June 6,
2011
Footnotes
☆A Spanish translated version of the abstract of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2011.12.026.
Identification
Copyright
© 2012 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
