Abstract 143: An Assessment of Who Dies After Cardiac Arrest in the Era of Therapeutic Hypothermia

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Katherine Zanyk McLean ◽  
Julie VanRaemdonck ◽  
Diane Capoccia ◽  
Carman Turkelson ◽  
William Devlin ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Therapeutic Hypothermia ◽  
Clinical Status ◽  
Treatment Protocol ◽  
Retrospective Chart Review ◽  
Spontaneous Circulation ◽  
Temperature Management ◽  
Traumatic Cardiac Arrest ◽  
Academic Center ◽  
The Gift

Introduction: Much emphasis is placed on who survives after cardiac arrest and how to optimize “good” outcomes. Despite this stress on aggressive post-arrest care and early temperature management, many people still die after admission to the hospital, often with care being withdrawn. The purpose of this study was to assess how and when patients die after undergoing in-hospital post-arrest therapeutic hypothermia (TH). Methods: This was a retrospective chart review of adult patients suffering non-traumatic cardiac arrest who had post-arrest care, including TH, initiated between January 2010 and June 2013 in a large, community academic center. All patients followed the same treatment protocol, with TH induced as soon as possible after arrest, regardless of initial rhythm or arrest location. Demographics, Utstein characteristics, and post-arrest variables, including time to withdrawal of care were collected until death or hospital discharge as part of an on-going quality improvement database. Descriptive statistics and associations are presented. Results: During the study period, 139 patients were included and 92 (66.2%) died prior to discharge (mean age 61.9 (SD 16.31) years, 88 (63.3%) male). Few (12, 13.0%) of these had early termination of the TH protocol or died (8, 10.0%) while intubated. Overall, 72 (78.3%) patients had care withdrawn. The median time from return of spontaneous circulation (ROSC) to withdrawal of care was 96.6 hours (IQR 66.2, 164.1) and 18 (27.3%) patients had care withdrawn <72 hours from ROSC. All patients were referred to the Gift of Life service but only 9 (12.5%) contributed to organ donation. A minority of patients (20, 27.8%) received a formal palliative care consult. Factors associated with withdrawal of care included family wishes, older age, initial non-shockable arrest rhythm, and longer time from arrest to ROSC. Conclusion: More than 75% of this cohort had care withdrawn. Although the majority had care withdrawn more than 72 hours after ROSC, early withdrawal of care was not uncommon. Further study of this group of patients is needed to understand the relationships between pre-arrest predictors of poor prognosis, pre-existing co-morbidities, patient clinical status, and family wishes on the early withdraw of care.

Abstract 19708: Pre-Hospital Initiation of Therapeutic Hypothermia Associated With Better Survival and Neurologic Outcome in a Broad Population of Patients in North Carolina

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Meena P Rao ◽  
Matthew Dupre ◽  
Carolina Hansen ◽  
Sarah Milford-Beland ◽  
Lisa Monk ◽  
...  
Keyword(s):  
North Carolina ◽  
Cardiac Arrest ◽  
Therapeutic Hypothermia ◽  
Spontaneous Circulation ◽  
Neurologic Outcome ◽  
Temperature Management ◽  
P Value ◽  
Return Of Spontaneous Circulation ◽  
Hospital Survival ◽  
Hospital Cardiac Arrest

Introduction: Out-of-hospital cardiac arrest (OHCA) has less than 10% hospital survival. While therapeutic hypothermia resulted in a 16%-24% improvement in neurologic outcome in patients with ventricular fibrillation (VF) in prior trials, recent trials have not shown benefit of pre-hospital initiation hypothermia or of hospital cooling to 33 vs 36 degrees. Methods: We studied patients who suffered OHCA in North Carolina from 2012-2013 captured in the CARES database as part of the Heart Rescue Project. To limit selection bias, we excluded patients without return of spontaneous circulation after arrest and without intubation in the field as they may have regained consciousness. Results: 847 patients were included in the analysis of pre-hospital hypothermia. The patients that received pre-hospital hypothermia had more bystander initiated CPR (p-value < 0.45). Pre-hospital hypothermia was associated with a significant increase in survival to hospital discharge (OR 1.55, 95% CI 1.03-2.32) and neurologic outcome at discharge (OR 1.56 95% CI 1.01-2.40). When looking at arrest types, the significant association was seen after VF arrest (figure). 537 patients survived to hospital admission and included in the analysis of in-hospital hypothermia. Patients who received hospital hypothermia were younger, had more VF, more witnessed arrest and more pre-hospital hypothermia. Hypothermia showed a non-significant trend toward better survival to discharge. Conclusions: The association between pre-hospital hypothermia after VF arrest and improved survival, in light of randomized data showing no effect, may be due to confounding or to a greater likelihood of in-hospital hypothermia in this group. The trend in better outcome using in-hospital hypothermia is consistent with a benefit from temperature management. These findings suggest the need for ongoing efforts to understand the value of hypothermia in context of other efforts to improve survival from cardiac arrest.

Abstract 161: Effectiveness of Lower Target Temperature Therapeutic Hypothermia for Post--Cardiac Arrest Victims Within 30 Minutes Resuscitation Interval

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Tadashi Kaneko ◽  
Shunji Kasaoka ◽  
Ken Nagao ◽  
Naohiro Yonemoto ◽  
Hiroyuki Yokoyama ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Therapeutic Hypothermia ◽  
Neurological Outcome ◽  
Propensity Score Analysis ◽  
Spontaneous Circulation ◽  
Temperature Management ◽  
Target Temperature Management ◽  
Target Temperature ◽  
Weighting Method ◽  
Favorable Neurological Outcome

Introduction: Therapeutic hypothermia (TH) for post cardiac arrest syndrome (PCAS) patients is standard strategy to reduce brain damage. However, current randomized control study (TTM: Target temperature management study, N Engl J Med 2013) suggested that simple target temperature did not improve outcome. Furthermore, there is no evidence, whether target temperature would be changed for each status of PCAS patients. Hypothesis: Lower target temperature could improve neurological outcome in PCAS patients. Methods: Participants with J-PULSE-Hypo study database were divided into the L group (32.0-33.9°C) and the M group (34-35°C). The favorable neurological outcomes (%, CPC 1-2 on 30th day) were compared between L and M groups in all and each subgroups with propensity score analysis with IPTW (inverse probability of treatment weighting) method as multivariate analysis. The subgroups were ages and interval from collapse to ROSC (return of spontaneous circulation). Results: 477 participants were analyzed. The comparison of each groups for favorable neurological outcome were that all groups (L: 64%, n = 42, vs M: 55%, n= 424, P = 0.234, multivariate: P = 0.452), age (≤60 y.o.) (L: 70% vs M: 67%, P = 0.717, multivariate: P = 0.657), age (>60 y.o.) (L: 50% vs M: 44%, P = 0.665, multivariate: P = 0.061), interval from collapse to ROSC (≤30 min.) (L: 88% vs M: 64%, P = 0.022, multivariate: P = 0.007), and interval from collapse to ROSC (>30 min.) (L: 21% vs M: 29%, P = 0.567, multivariate: P = 0.449). Conclusions: The PCAS victims within 30 min. from collapse to ROSC, would be treated by TH with less than 34°C target temperature.

Rhabdomyolysis following therapeutic hypothermia after traumatic cardiac arrest

Resuscitation ◽  
2011 ◽  
Vol 82 (4) ◽  
pp. 493 ◽  
Author(s):  
M. Ciapetti ◽  
S. di Valvasone ◽  
R. Spina ◽  
A. Peris
Keyword(s):  
Cardiac Arrest ◽  
Therapeutic Hypothermia ◽  
Traumatic Cardiac Arrest

scholarly journals Efficacy of Targeted Temperature Management after Pediatric Cardiac Arrest: A Meta-Analysis of 2002 Patients

2021 ◽  
Vol 10 (7) ◽  
pp. 1389
Author(s):  
Wojciech Wieczorek ◽  
Jarosław Meyer-Szary ◽  
Milosz J. Jaguszewski ◽  
Krzysztof J. Filipiak ◽  
Maciej Cyran ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Survival Rate ◽  
Adverse Events ◽  
Therapeutic Hypothermia ◽  
Hospital Discharge ◽  
Fixed Effects ◽  
Meta Analysis ◽  
Targeted Temperature Management ◽  
Temperature Management ◽  
One Year

Cardiac arrest (CA) is associated with high mortality and poor life quality. Targeted temperature management (TTM) or therapeutic hypothermia is a therapy increasing the survival of adult patients after CA. The study aim was to assess the feasibility of therapeutic hypothermia after pediatric CA. We performed a systematic review and meta-analysis of randomized controlled trials and observational studies evaluating the use of TTM after pediatric CA. The primary outcome was survival to hospital discharge or 30-day survival. Secondary outcomes included a one-year survival rate, survival with a Vineland adaptive behavior scale (VABS-II) score ≥ 70, and occurrence of adverse events. Ten articles (n = 2002 patients) were included, comparing TTM patients (n = 638) with controls (n = 1364). In a fixed-effects meta-analysis, survival to hospital discharge in the TTM group was 49.7%, which was higher than in the non-TTM group (43.5%; odds ratio, OR = 1.22; 95% confidence interval, CI: 1.00, 1.50; p = 0.06). There were no differences in the one-year survival rate or the occurrence of adverse events between the TTM and non-TTM groups. Altogether, the use of TTM was associated with a higher survival to hospital discharge; however, it did not significantly increase the annual survival. Additional high-quality prospective studies are necessary to confer additional TTM benefits.

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.

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.

Prehospital predictors for return of spontaneous circulation in traumatic cardiac arrest

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Axel Benhamed ◽  
Valentine Canon ◽  
Eric Mercier ◽  
Matthieu Heidet ◽  
Amaury Gossiome ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Spontaneous Circulation ◽  
Return Of Spontaneous Circulation ◽  
Traumatic Cardiac Arrest

Abstract 324: Assessment in Therapeutic Hypothermia Protocol: A Quality Assessment Initiative and Analysis of Hemodynamic and Laboratory Parameters

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Ediz Tasan ◽  
Alison Bailey ◽  
Charles Campbell
Keyword(s):  
Logistic Regression ◽  
Cardiac Arrest ◽  
Therapeutic Hypothermia ◽  
Spontaneous Circulation ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Laboratory Parameters ◽  
Logistic Regression Models ◽  
Discharge Disposition ◽  
Home Discharge

Background: Therapeutic hypothermia (TH) is often considered for comatose patients with return of spontaneous circulation after cardiac arrest (CA). While patients undergoing out-of-hospital ventricular fibrillation cardiac arrest are thought to benefit most from TH, the individualized benefit of initiating TH is unknown. Using a combination of clinical and laboratory parameters at presentation, we sought a model to predict survival and discharge to home. Methods: We performed a retrospective study of patients undergoing TH after CA at the University of Kentucky Hospital from 4/1/11 to 12/31/13. Records confirmed by chart review. The primary outcomes were discharge disposition and death. We conducted logistic regression analyses to identify predictors of home discharge and survival. Results: The series included 80 patients (mean±SD age was 55.2±14.9, and 61% were male). The overall mortality rate was 67.9% with survivor home discharge disposition of 21.2%. The Apache II Score (estimated odds ratio [OR] 1.167) was a significant predictor of death; moreover, though not itself a significant predictor of death, troponin improved the ability of Apache II to predict death. The Apache II Score (OR 0.882) and Mean Arterial Pressure (OR 1.049) were significant predictors of home discharge. Figures 1 and 2 display estimated probabilities of survival and home discharge based on two-predictor logistic regression models. Conclusions: In patients undergoing TH, a favorable prognosis is anticipated given certain values for hemodynamic and laboratory parameters. Thus, the patient’s clinical presentation may provide additional guidance when considering initiation of TH after CA.

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