The Relationship Between the Decreased Rate of Initial Blood Glucose and Neurologic Outcomes in Survivors of Out-of-Hospital Cardiac Arrest Receiving Therapeutic Hypothermia

Background: The therapeutic hypothermia protocol for out of hospital cardiac arrest is not standardized and the decision to apply therapeutic hypothermia relies on a physician’s judgment. Elderly patients who rely on this judgment are less likely to receive therapeutic hypothermia. Objectives: This study aimed to provide an analysis of the impact and utility of therapeutic hypothermia on elderly out of hospital cardiac arrest. Methods: This was a multicenter, retrospective, observational, registry-based study from 2007 to 2012. Adults who suffered out-of-hospital cardiac arrest and were treated with therapeutic hypothermia were included. We divided the patients into a group of elderly patients 65 years or older and a group of young adults under 65 years old and compared the neurologic outcomes and adverse events after one-to-one matching by propensity score. Results: In total, 930 patients were enrolled in the study. Among these patients, 343 were ⩾65 years, while 587 were <65 years. Of the adverse events in therapeutic hypothermia, hyperglycemia (51.31%), hypotension (41.98%) during cooling was more frequent in aged ⩾65 years and rebound hyperthermia (7.14%) and hypotension (29.93%) during rewarming. After propensity score matching was applied to all subjects of the study, 247 matched pairs of patients were available. The two groups showed no statistically significant difference in the adverse events during therapeutic hypothermia. Conclusion: Elderly patients exhibited a decreased survival to hospital discharge and good neurologic outcomes. The two groups showed no differences in the frequency of adverse events during therapeutic hypothermia, when comparing in a propensity score matching cohort analysis.

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Therapeutic Hypothermia and Out-of-Hospital Cardiac Arrest in a Child with Hypertrophic Obstructive Cardiomyopathy

Case Reports in Pediatrics ◽

10.1155/2015/796151 ◽

2015 ◽

Vol 2015 ◽

pp. 1-3

Author(s):

Nancy Spurkeland ◽

Gregory Bennett ◽

Chandran Alexander ◽

Dennis Chang ◽

Gary Ceneviva

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Therapeutic Hypothermia ◽

Positive Outcome ◽

Hypertrophic Obstructive Cardiomyopathy ◽

Early Initiation ◽

National Guidelines ◽

Positive Effects ◽

Neurologic Outcomes ◽

Hospital Cardiac Arrest

Neurologic outcomes following pediatric cardiac arrest are consistently poor. Early initiation of cardiopulmonary resuscitation has been shown to have positive effects on both survival to hospital discharge, and improved neurological outcomes after cardiac arrest. Additionally, the use of therapeutic hypothermia may improve survival in pediatric cardiac arrest patients admitted to the intensive care unit. We report a child with congenital hypertrophic obstructive cardiomyopathy and an out-of-hospital cardiac arrest, in whom the early initiation of effective prolonged cardiopulmonary resuscitation and subsequent administration of therapeutic hypothermia contributed to a positive outcome with no gross neurologic sequelae. Continuing efforts should be made to promote and employ high-quality cardiopulmonary resuscitation, which likely contributed to the positive outcome of this case. Further research will be necessary to develop and solidify national guidelines for the implementation of therapeutic hypothermia in selected subpopulations of children with OHCA.

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