Safety, feasibility, and outcomes of induced hypothermia therapy following in-hospital cardiac arrest-evaluation of a large prospective registry*.

Abstract

OBJECTIVES:

Despite a lack of randomized trials, practice guidelines recommend that mild induced hypothermia be considered for comatose survivors of in-hospital cardiac arrest. This study describes the safety, feasibility, and outcomes of mild induced hypothermia treatment following in-hospital cardiac arrest.

DESIGN:

Prospective, observational, registry-based study.

SETTING:

Forty-six critical care facilities in eight countries in Europe and the United States reporting in the Hypothermia Network Registry and the International Cardiac Arrest Registry.

PATIENTS:

A total of 663 patients with in-hospital cardiac arrest and treated with mild induced hypothermia were included between January 2004 and February 2012.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

A cerebral performance category of 1 or 2 was considered a good outcome. At hospital discharge 41% of patients had a good outcome. At median 6-month follow-up, 34% had a good outcome. Among in-hospital deaths, 52% were of cardiac causes and 44% of cerebral cause. A higher initial body temperature was associated with reduced odds of a good outcome (odds ratio, 0.79; 95% CI, 0.68-0.92). Adverse events were common; bleeding requiring transfusion (odds ratio, 0.56; 95% CI, 0.31-1.00) and sepsis (odds ratio, 0.52; 95% CI, 0.30-0.91) were associated with reduced odds for a good outcome.

CONCLUSIONS:

In this registry study of an in-hospital cardiac arrest population treated with mild induced hypothermia, we found a 41% good outcome at hospital discharge and 34% at follow-up. Infectious complications occurred in 43% of cases, and 11% of patients required a transfusion for bleeding. The majority of deaths were of cardiac origin.

• Authors: Josef Dankiewicz, Simon Schmidbauer, Niklas Nielsen, Karl B Kern, Michael R Mooney, Pascal Stammet, Richard R Riker, Sten Rubertsson, David Seder, Ondrej Smid, Kjetil Sunde, Eldar Søreide, Barbara T Unger, Hans Friberg
• Journal: Critical care medicine (Crit Care Med) Vol. 42 Issue 12 Pg. 2537-45 (Dec 2014) ISSN: 1530-0293 [Electronic] United States
• PMID: 25083981 (Publication Type: Journal Article, Multicenter Study, Observational Study, Research Support, Non-U.S. Gov't)

Topics

• Age Factors
• Aged
• Arrhythmias, Cardiac
• Body Temperature
• Coma (epidemiology)
• Comorbidity
• Critical Care (methods)
• Female
• Health Status Indicators
• Heart Arrest (complications, therapy)
• Humans
• Hypothermia, Induced (methods, mortality)
• Male
• Middle Aged
• Prospective Studies
• Registries
• Sex Factors
• Time Factors
• Treatment Outcome