Abstract P65: Community Based Application of Therapeutic Hypothermia for Survivors of Cardiac Arrest

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Roger Getts ◽  
David Fedor ◽  
Vincent J Vanston ◽  
Mary Triano ◽  
John Prior
Keyword(s):  
Cardiac Arrest ◽  
Therapeutic Hypothermia ◽  
Spontaneous Circulation ◽  
Mild Therapeutic Hypothermia ◽  
Community Based ◽  
Simple Protocol ◽  
The Us ◽  
Good Neurologic Outcome ◽  
The Mean ◽  
Mean Time

Objectives: To demonstrate that the application of therapeutic hypothermia is technically feasible in a community-based setting. Background: Implementation of therapeutic hypothermia for survivors of cardiac arrest in the US has been slow, at least partially because of the perception that this therapy is technically difficult, especially at the community level. Scranton, Pennsylvania is a just such a community. It has 75,000 people served by 3 hospitals with 700 acute care beds. Methods: At three community hospitals, after return of spontaneous circulation (ROSC) survivors of cardiac arrest were treated with mild therapeutic hypothermia using ice and cooling blankets or suits in order to achieve a goal temperature of 32 to34 degrees C for 24 hours. After ROSC, the timing goals of therapeutic hypothermia were to cool patients within 4 hours, to achieve goal temperature within 8 hours, and to maintain goal temperature for 24 hours. Results: Beginning in 2004, 27 survivors of cardiac arrest were managed with therapeutic hypothermia. The mean time from ROSC to initiation of therapeutic hypothermia was 2.8 hours (range, 0.4 – 6.3 hours), the mean time from ROSC to goal temperature was 6.9 hours (range, 1.9 –15 hours), and the mean time maintained at goal temperature was 26.7 hours (range, 12–39 hours). Once patients achieved goal temperature, 4.3% of the temperature readings were above 34 degrees C, reflecting undercooling, while 13.4% of the readings were below 32 degrees C, indicative of overcooling. Overall survival until hospital discharge with good neurologic outcome was 52%, compared to only 12% (p < 0.001) among historical controls with cardiac arrest. There were no major complications attributable to the procedure. Conclusion: A simple protocol of mild therapeutic hypothermia using locally-available resources is technically feasible and safe in a community-based setting.

Abstract 13131: The Priority of Coronary Arteriography and Therapeutic Hypothermia After Return of Spontaneous Circulation in Patients With Out-of-hospital Cardiac Arrest. the Result of Sos-kanto 2012 Study

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Shuichi Hagiwara ◽  
Kiyohiro Oshima ◽  
Masato Murata ◽  
Makoto Aoki ◽  
Kei Hayashida ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Therapeutic Hypothermia ◽  
Statistical Significance ◽  
Coronary Arteriography ◽  
Spontaneous Circulation ◽  
P Value ◽  
Return Of Spontaneous Circulation ◽  
Overall Performance ◽  
The Mean ◽  
Hospital Cardiac Arrest

Aim: To evaluate the priority of coronary angiography (CAG) and therapeutic hypothermia therapy (TH) after return of spontaneous circulation (ROSC) in patients with out-of-hospital cardiac arrest (OHCA). Patients and Methods: SOS-KANTO 2012 study is a prospective, multicenter (69 emergency hospitals) and observational study and includes 16,452 patients with OHCA. Among the cases with ROSC in that study, we intended for patients treated with both CAG and TH within 24 hours after arrival. Those patients were divided into two groups; patients in whom TH was firstly performed (TH group), and the others in whom CAG was firstly done (CAG group). We statistically compared the prognosis between the two groups. SPSS Statistics 22 (IBM, Tokyo, Japan) was used for the statistical analysis. Statistical significance was assumed to be present at a p value of less than 0.05. Result: 233 patients were applied in this study. There were 86 patients in the TH group (M/F: 74/12, mean age; 60.0±15.2 y/o) and 147 in the CAG group (M/F: 126/21, mean age: 63.4±11.1 y/o) respectively, and no significant differences were found in the mean age and M/F ratio between the two groups. The overall performance categories (OPC) one month after ROSC in the both groups were as follows; in the TH group, OPC1: 21 (24.4%), OPC2: 3 (3.5%), OPC3: 7 (8.1%), OPC4: 8 (9.3%), OPC5: 43 (50.0%), unknown: 4 (4.7%), and in the CAG group, OPC1: 38 (25.9%), OPC2: 13 (8.8%), OPC3: 15 (10.2%), OPC4: 18 (12.2%), OPC5: 57 (38.8%), unknown: 6 (4.1%). There were no significant differences in the prognosis one month after ROSC between the two groups. Conclusion: The results which of TH and CAG you give priority to over do not affect the prognosis in patients with OHCA.

Abstract 333: A Prospective Study of the Incidence of Intracranial Hemorrhage in Survivors of Out of Hospital Cardiac Arrest

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Jonathan Gelber ◽  
Martha E Montgomery ◽  
Amandeep Singh
Keyword(s):  
Cardiac Arrest ◽  
Hospital Admission ◽  
Prospective Study ◽  
Intracranial Hemorrhage ◽  
Spontaneous Circulation ◽  
Neurologic Outcome ◽  
The Us ◽  
Good Neurologic Outcome ◽  
A Prospective Study ◽  
Hospital Cardiac Arrest

Introduction: Intracranial Hemorrhage (ICH) is an important cause of out-of-hospital cardiac arrest (OHCA), yet there are no United States (US), European, or Australian prospective studies examining its incidence. A single Japanese prospective study found a high incidence of ICH in survivors of OHCA (18.3% incidence), but that data is not generalizable to the US, which has a far lower overall rate of ICH. Aim: This study aims to identify the incidence of ICH in US patients with OHCA who obtain return of spontaneous circulation (ROSC). Methods: We prospectively analyzed all consecutive patients with OHCA who achieved ROSC at a single US hospital over a 15-month period from 2018-2020. A standardized order set, including non-contrast head computed-tomography (NCH-CT), was recommended as part of the initial management for all patients with ROSC after OHCA. Patient and cardiac arrest variables were recorded, as were NCH-CT findings. Results: During the study period, 194 patients presents to the emergency department with OHCA, and 95 patients achieved ROSC and survived to hospital admission. A NCH-CT was obtained in 85/95 patients (89.5%). Twenty-four of 85 patients (28.2%) survived to hospital discharge. Three of 85 patients with NCH-CT had ICH (3.5%). Survival with good neurologic outcome was seen in 14/82 (17.1%) patients without ICH and in 0/3 patients with ICH. Patients with ICH were significantly older than patients without ICH (86.7 years versus 64.4 years, p=0.01). Conclusions: In our US cohort, ICH was an uncommon finding in patients who sustained OHCA and survived to hospital admission. The incidence of ICH in survivors of OHCA was 3.5%, lower than previously reported retrospective data in the US, and much lower than reported in a prospective Japanese study. No patients with ICH survived with good neurologic outcome.

scholarly journals Therapeutic Hypothermia after Cardiac Arrest: Experience at an Academically Affiliated Community-Based Veterans Affairs Medical Center

2011 ◽  
Vol 2011 ◽  
pp. 1-8 ◽  
Author(s):  
Maulik P. Shah ◽  
Leslie Zimmerman ◽  
Jean Bullard ◽  
Midori A. Yenari
Keyword(s):  
Cardiac Arrest ◽  
Therapeutic Hypothermia ◽  
Medical Center ◽  
Cerebral Performance Category ◽  
Case Series ◽  
Pulseless Electrical Activity ◽  
Community Setting ◽  
Veterans Affairs ◽  
Community Based ◽  
Mean Time

At laboratory and clinical levels, therapeutic hypothermia has been shown to improve neurologic outcomes and mortality following cardiac arrest. We reviewed each cardiac arrest in our community-based Veterans Affairs Medical Center over a three-year period. The majority of cases were in-hospital arrests associated with initial pulseless electrical activity or asystole. Of a total of 100 patients suffering 118 cardiac arrests, 29 arrests involved comatose survivors, with eight patients completing therapeutic cooling. Cerebral performance category scores at discharge and six months were significantly better in the cooled cohort versus the noncooled cohort, and, in every case except for one, cooling was offered for appropriate reasons. Mean time to initiation of cooling protocol was 3.7 hours and mean time to goal temperature of 33∘C was 8.8 hours, and few complications clearly related to cooling were noted in our case series. While in-patient hospital mortality of cardiac arrest was high at 65% mortality during hospital admission, therapeutic hypothermia was safe and feasible at our center. Our cooling times and incidence of favorable outcomes are comparable to previously published reports. This study demonstrates the feasibility of implementing, a cooling protocol a community setting, and the role of neurologists in ensuring effective hospital-wide implementation.

Community-Based Application of Mild Therapeutic Hypothermia for Survivors of Cardiac Arrest

2010 ◽  
Vol 103 (4) ◽  
pp. 295-300 ◽  
Author(s):  
John Prior ◽  
Mary Lawhon-Triano ◽  
David Fedor ◽  
Vincent J. Vanston ◽  
Roger Getts ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Therapeutic Hypothermia ◽  
Mild Therapeutic Hypothermia ◽  
Community Based

4034Distance from hospital as an early marker of outcomes in out of hospital cardiac arrest acute myocardial infarction survivors treated with endovascular mild therapeutic hypothermia

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
D Hetclova ◽  
M Hutyra ◽  
J Precek ◽  
O Moravec ◽  
T Skala ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Cardiac Arrest ◽  
Therapeutic Hypothermia ◽  
Spontaneous Circulation ◽  
Mild Therapeutic Hypothermia ◽  
Circulation Time ◽  
Left Ventricular Ejection ◽  
Return Of Spontaneous Circulation ◽  
Hospital Cardiac Arrest

Abstract Background The prediction of outcome in comatose patients after out of hospital cardiac arrest (OHCA) has major ethical and socioeconomic implications. At present, there is a lack of data comparing the predictive value from cardiac arrest localization to hospital distance in OHCA survivors treated with endovascular therapeutic hypothermia. Methods 86 patients (64±14 years, 69 men) were evaluated after OHCA due to ventricular fibrillation (VF) during an acute myocardial infarction (MI). All patients (NSTEMI 28%, STEMI 72%) were indicated for urgent coronary angiography, echocardiography for left ventricular ejection fraction (LVEF) estimation using Simpson biplane formula and treated with mild therapeutic hypothermia (MTH) using intravascular temperature management to maintain target temperature (33 °C) for 24 hours. The Cerebral Performance Categories scale (CPC) was used as the outcome measure and was assessed 3 months post admission; a CPC of 3–5 was regarded as a poor outcome (n=45), and a CPC of 1–2 (n=41) as a good outcome. Results Distance to hospital was significantly higher (p=0.0473) in patients with poor outcomes (CPC 3–5) after OHCA (37.5±4.5 km) compared with CPC 1–2 patients (27.1±4.4 km). No significant differences in return of spontaneous circulation time (21; 10.5–47.5 95th percentile vs. 23; 10.0–50.0, p=0.738), lactate (7.8; 4.5–12.4 vs. 8.4; 5.4–13.5, p=0.54), LVEF (40; 22–50 vs. 40; 21–62%, p=0.208), peak cardiac troponin T (1.5; 0.08–10.00 vs. 0.64; 0.04–5.28 μg/L, p=0.078), NSE (29.2; 15.7–54.9 vs. 25.8; 13.6–52.3 μg/L, p=0.26) and S100-B (0.17; 0.09–1.69 vs. 0.19; 0.04–1.14 μg/L, p=0.734) were found in CPC 3–5 and CPC 1–2 groups comparison. Using an optimal cut-off value ≥33 km calculated from the receiver operating characteristic curve (area under curve = 0.62; p=0.004), the sensitivity of predicting survival with poor neurological outcome was 61% and the specificity was 62%. Conclusions In patients after OHCA for VF during MI, distance from cardiac arrest localization to hospital gives reliable and on return of spontaneous circulation time independent prognostic information concerning outcome after cardiopulmonary resuscitation. Acknowledgement/Funding Grant support FNOL RIV 87-85

Abstract 18656: The Effect of Targeted Temperature Management is Dependent Upon the Duration of Out-of-hospital Cardiac Arrest

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Ian R Drennan ◽  
Steve Lin ◽  
Kevin E Thorpe ◽  
Jason E Buick ◽  
Sheldon Cheskes ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Hospital Discharge ◽  
Spontaneous Circulation ◽  
Targeted Temperature Management ◽  
Neurologic Outcome ◽  
Temperature Management ◽  
Neurologic Injury ◽  
Good Neurologic Outcome ◽  
The Impact ◽  
Hospital Cardiac Arrest

Introduction: Targeted temperature management (TTM) reduces neurologic injury from out-of-hospital cardiac arrest (OHCA). As the risk of neurologic injury increases with prolonged cardiac arrests, the benefit of TTM may depend upon cardiac arrest duration. We hypothesized that there is a time-dependent effect of TTM on neurologic outcomes from OHCA. Methods: Retrospective, observational study of the Toronto RescuNET Epistry-Cardiac Arrest database from 2007 to 2014. We included adult (>18) OHCA of presumed cardiac etiology that remained comatose (GCS<10) after a return of spontaneous circulation. We used multivariable logistic regression to determine the effect of TTM and the duration of cardiac arrest on good neurologic outcome (Modified Rankin Scale (mRS) 0-3) and survival to hospital discharge while controlling for other known predictors. Results: There were 1496 patients who met our inclusion criteria, of whom 981 (66%) received TTM. Of the patients who received TTM, 59% had a good neurologic outcome compared to 39% of patients who did not receive TTM (p< 0.001). After adjusting for the Utstein variables, use of TTM was associated with improved neurologic outcome (OR 1.60, 95% CI 1.10-2.32; p = 0.01) but not with survival to discharge (OR 1.23, 95% CI 0.90-1.67; p = 0.19). The impact of TTM on neurologic outcome was dependent on the duration of cardiac arrest (p<0.05) (Fig 1). Other significant predictors of good neurologic outcome were younger age, public location, initial shockable rhythm, and shorter duration of cardiac arrest (all p values < 0.05). A subgroup analysis found the use of TTM to be associated with neurologic outcome in both shockable (p = 0.01) and non-shockable rhythms (p = 0.04) but was not associated with survival to discharge in either group (p = 0.12 and p = 0.14 respectively). Conclusion: The use of TTM was associated with improved neurologic outcome at hospital discharge. Patients with prolonged durations of cardiac arrest benefited more from TTM.

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