Skip to main content Accessibility help
×
Home

Clinical Outcomes in Cardiac Arrest Patients Following Prehospital Treatment with Therapeutic Hypothermia

  • Eric Cortez (a1) (a2), Ashish R. Panchal (a3), James Davis (a1), Paul Zeeb (a4) and David P. Keseg (a1) (a3)...

Abstract

Introduction

Recent studies have brought to question the efficacy of the use of prehospital therapeutic hypothermia for victims of out-of-hospital cardiac arrest (OHCA). Though guidelines recommend therapeutic hypothermia as a critical link in the chain of survival, the safety of this intervention, with the possibility of minimal treatment benefit, becomes important.

Hypothesis/Problem

This study examined prehospital therapeutic hypothermia for OHCA, its association with survival, and its complication profile in a large, metropolitan, fire-based Emergency Medical Services (EMS) system, where bystander cardiopulmonary resuscitation (CPR) and post-arrest care are in the process of being optimized.

Methods

This evaluation was a retrospective chart review of all OHCA patients with return of spontaneous circulation (ROSC) treated with therapeutic hypothermia, from January 1, 2013 through November 30, 2013. The primary outcomes were the proportion of patients with initiation of prehospital therapeutic hypothermia with survival to hospital admission, the proportion of patients with initiation of prehospital therapeutic hypothermia with survival to hospital discharge, and the complication profile of therapeutic hypothermia in this population. The complication profile included several clinical, radiographic, and laboratory parameters. Exclusion criteria included: no prehospital therapeutic hypothermia initiation; no ROSC; and age of 17 year old or younger.

Results

Fifty-one post-cardiac arrest patients were identified that met inclusion criteria. The mean age was 61 years (SD=14.7 years), and 33 (72%) were male. The initial rhythm was ventricular fibrillation or pulseless ventricular tachycardia in 17 (37%) patients, and bystander CPR was performed in 28 (61%) patients with ROSC. Thirty-nine (85%) patients survived to hospital admission. Twenty-one patients (48%; 95% CI, 33-64) were administered vasopressors, 10 patients (24%; 95% CI, 10-37) were administered diuretics, and 19 patients (44%; 95% CI, 29-60) were administered antibiotics. Initial chest radiograph (CXR) findings were normal in 12 (29%) patients. Overall, 13 (28%; 95% CI, 15-42) study patients survived to hospital discharge.

Conclusion

Recent reports have questioned the efficacy and safety of prehospital therapeutic hypothermia. In this evaluation, in the setting of unstandardized post-arrest care, 85% of the patients survived to hospital admission and 28% survived to hospital discharge, with a complication profile which was similar to that noted in other studies. This suggests that further evidence may be needed before EMS systems stop administering therapeutic hypothermia to appropriately selected patients. In less-optimized systems, therapeutic hypothermia may still be an essential link in the chain of survival.

Cortez E , Panchal AR , Davis J , Zeeb P , Keseg DP . Clinical Outcomes in Cardiac Arrest Patients Following Prehospital Treatment with Therapeutic Hypothermia. Prehosp Disaster Med 2015; 30(5):452456.

Copyright

Corresponding author

Correspondence: Eric Cortez, MD 3639 South Parsons Ave Columbus, Ohio 43207 USA E-mail: ejcortez@columbus.gov

References

Hide All
1. The American Heart Association. Cardiac Arrest Statistics. Heart Disease and Stroke Statistics – 2013. American Heart Association Web site. http://www.heart.org/HEARTORG/General/Cardiac-Arrest-Statistics_UCM_448311_Article.jsp. Accessed January 30, 2015.
2. Travers, AH, Rea, TD, Bobrow, BJ, et al. 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care science. Part 4: CPR overview. Circulation. 2010;122(suppl 3):S676-S684.
3. Perberdy, MA, Callaway, CW, Neumar, RW, et al. 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care science. Part 9: post-cardiac arrest care. Circulation. 2010;122(suppl 3):S768-S786.
4. The Hypothermia after Cardiac Arrest Study Group. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med. 2002;346(22):549-556.
5. Bernard, SA, Gray, TW, Buist, MD, et al. Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med. 2002;346(8):557-563.
6. Kuboyama, K, Safar, P, Radovsky, A, Tisherman, SA, Stezoski, SW, Alexander, H. 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(9):1348-1358.
7. Bernard, S, Buist, M, Monteiro, O, Smith, K. Induced hypothermia using large volume, ice-cold intravenous fluid in comatose survivors of out-of-hospital cardiac arrest: a preliminary report. Resuscitation. 2003;56(1):9-13.
8. Cady, C, Andrews, S. Prehospital resuscitated cardiac arrest patients: role for induced hypothermia. Resource paper for the NAEMSP position paper on induced therapeutic hypothermia in resuscitated cardiac arrest patients. Prehosp Emerg Care. 2009;13(3):402-405.
9. Nolan, JP, Morley, PT, Hoek, V, et al. Therapeutic hypothermia after cardiac arrest: an advisory statement by the Advanced Life Support Tasks Force of the International Liaison Committee on Resuscitation. Circulation. 2003;108(1):118-121.
10. Kim, F, Olsufka, M, Longstreth, WT, 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°C normal saline. Circulation. 2007;115(24):3064-3070.
11. Bernard, SA, Smith, K, Cameron, P, et al. Induction of therapeutic hypothermia by paramedics after resuscitation from out-of-hospital ventricular fibrillation cardiac arrest: a randomized controlled trial. Circulation. 2010;122(7):737-742.
12. Nielsen, N, Wetterslev, J, Cronberg, T, et al. Targeted temperature management at 33°C versus 36°C after cardiac arrest. N Engl J Med. 2013;369(23):2197-2206.
13. Kim, F, Nichol, G, Maynard, C, et al. Effect of prehospital induction of mild hypothermia on survival and neurological status among adults with cardiac arrest: a randomized clinical trial. JAMA. 2014;311(1):45-52.
14. Centers for Disease Control and Prevention. Cardiac Arrest Registry to Enhance Survival. CDC Web site. mycares.net. Accessed January 30, 2015.
15. City of Columbus. Division of Fire Standard Operating Procedure. SOP Number 07-02-29. Therapeutic Hypothermia. Effective Date July 1, 2014.

Keywords

Related content

Powered by UNSILO

Clinical Outcomes in Cardiac Arrest Patients Following Prehospital Treatment with Therapeutic Hypothermia

  • Eric Cortez (a1) (a2), Ashish R. Panchal (a3), James Davis (a1), Paul Zeeb (a4) and David P. Keseg (a1) (a3)...

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed.