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).
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.
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).
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.
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- Executive summary: heart disease and stroke statistics—2010 update: a report from the American Heart Association.Circulation. 2010; 121: 948-954
- Incidence of treated cardiac arrest in hospitalized patients in the United States.Crit Care Med. 2011;
- Regional variation in out-of-hospital cardiac arrest incidence and outcome.JAMA. 2008; 300: 1423-1431
- Cardiac Arrest Resuscitation Evaluation in Los Angeles: CARE-LA.Ann Emerg Med. 2005; 45: 504-509
- Experiences from treatment of out-of-hospital cardiac arrest during 17 years in Goteborg.Eur Heart J. 2000; 21: 1251-1258
- Cost-effectiveness analysis of potential improvements to emergency medical services for victims of out-of-hospital cardiac arrest.Ann Emerg Med. 1996; 27: 711-720
- Comparison of the Cerebral Performance Category score and the Health Utilities Index for survivors of cardiac arrest.Ann Emerg Med. 2009; 53: 241
- Out-of-hospital cardiac arrests in Amsterdam and its surrounding areas: results from the Amsterdam resuscitation study (ARREST) in ‘Utstein’ style.Resuscitation. 1998; 38: 157-167
- First documented rhythm and clinical outcome from in-hospital cardiac arrest among children and adults.JAMA. 2006; 295: 50-57
- Cardiopulmonary resuscitation of adults in the hospital: a report of 14720 cardiac arrests from the National Registry of Cardiopulmonary Resuscitation.Resuscitation. 2003; 58: 297-308
- Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia.N Engl J Med. 2002; 346: 563
- Outcome, timing and adverse events in therapeutic hypothermia after out-of-hospital cardiac arrest.Acta Anaesthesiol Scand. 2009; 53: 926-934
- Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest.N Engl J Med. 2002; 346: 549-556
- Systematic review of randomized controlled trials of therapeutic hypothermia as a neuroprotectant in post cardiac arrest patients.CJEM. 2006; 8: 329-337
- Advancement Life support Task Force of the International Liaison committee on Resuscitation. Therapeutic hypothermia after cardiac arrest. An advisory statement by the Advancement Life support Task Force of the International Liaison committee on Resuscitation.Resuscitation. 2003; 57: 231-235
- Part 9. Post-cardiac arrest care: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.Circulation. 2010; 122: S768-S786
- The feasibility of a regional cardiac arrest receiving system.Resuscitation. 2007; 74: 44-51
- Cochrane corner: hypothermia for neuroprotection in adults after cardiopulmonary resuscitation.Anesth Analg. 2010; 110: 1239
- Induction of therapeutic hypothermia by paramedics after resuscitation from out-of-hospital ventricular fibrillation cardiac arrest: a randomized controlled trial.Circulation. 2010; 122: 737-742
- Postresuscitation care: entering a new era.Curr Opin Crit Care. 2010; 16: 216-222
- The role of hypothermia in post-cardiac arrest patients with return of spontaneous circulation: a systematic review.Resuscitation. 2011; 82: 508-516
- Methods of cooling: practical aspects of therapeutic temperature management.Crit Care Med. 2009; 37: S211-S222
- Therapeutic hypothermia after cardiac arrest: monitoring hypothermia in intensive care units.Anaesthesia. 2010; 65: 753-754
- Assessment of outcome after severe brain damage.Lancet. 1975; 1: 480-484
- A randomized clinical study of cardiopulmonary-cerebral resuscitation: design, methods, and patient characteristics. Brain Resuscitation Clinical Trial I Study Group.Am J Emerg Med. 1986; 4: 72-86
- Recommended guidelines for uniform reporting of data from out-of-hospital cardiac arrest: the Utstein Style. A statement for health professionals from a task force of the American Heart Association, the European Resuscitation Council, the Heart and Stroke Foundation of Canada, and the Australian Resuscitation Council.Circulation. 1991; 84: 960-975
- Brain Fail Resusc. 1981;
- Cognitive dysfunction and health-related quality of life after a cardiac arrest and therapeutic hypothermia Cognition after therapeutic hypothermia.Acta Anaesthesiol Scand. 2010; 54: 721-728
- On extending the indications for the use of therapeutic hypothermia.Crit Care Med. 2009; 37: 2865
- Therapeutic hypothermia after out-of-hospital cardiac arrest: evaluation of a regional system to increase access to cooling.Circulation. 2011; 124: 206-214
- Regression models for categorical dependent variables using Stata.Stata Press, College Station, TX2006
- Stata Statistical Software: Release 11. 0.2010 ([computer program,)
- Intra-arrest cooling improves outcomes in a murine cardiac arrest model.Circulation. 2004; 109: 2786-2791
- Delay in cooling negates the beneficial effect of mild resuscitative cerebral hypothermia after cardiac arrest in dogs: a prospective, randomized study.Crit Care Med. 1993; 21: 1348-1358
- Intra-arrest transnasal evaporative cooling: a randomized, prehospital, multicenter study (PRINCE: Pre-ROSC IntraNasal Cooling Effectiveness).Circulation. 2010; 122: 729-736
- Predictors of poor neurologic outcome in patients undergoing therapeutic hypothermia after cardiac arrest.South Med J. 2010; 103: 301-306
- Early achievement of mild therapeutic hypothermia and the neurologic outcome after cardiac arrest.Int J Cardiol. 2009; 133: 223-228
- Predictors of poor neurologic outcome in patients after cardiac arrest treated with hypothermia: a retrospective study.Resuscitation. 2011;
- Hypothermia for neuroprotection after cardiac arrest: systematic review and individual patient data meta-analysis.Crit Care Med. 2005; 33 ([see comment]): 414-418
- Resuscitation after brain ischemia.in: Clinics in critical care medicine, brain failure and resuscitation. vol. 2. Churchill Livingstone, New York/Edinburgh/London/Melbourne1981: 155-184
Published online: January 09, 2012
Accepted: December 7, 2011
Received in revised form: November 29, 2011
Received: June 6, 2011
☆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.
© 2012 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.