Safety, feasibility, and outcomes of induced hypothermia therapy following in-hospital cardiac arrest-evaluation of a large prospective registry*.
Critical care medicine
Age Factors, Aged, Arrhythmias, Cardiac, Body Temperature, Coma, Comorbidity, Critical Care, Female, Health Status Indicators, Heart Arrest, Humans, Hypothermia, Induced, Male, Middle Aged, Prospective Studies, Registries, Sex Factors, Time Factors, Treatment Outcome
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.
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.
Dankiewicz, Josef; Schmidbauer, Simon; Nielsen, Niklas; Kern, Karl B; Mooney, Michael R; Stammet, Pascal; Riker, Richard R; Rubertsson, Sten; Seder, David; Smid, Ondrej; Sunde, Kjetil; Søreide, Eldar; Unger, Barbara T; and Friberg, Hans, "Safety, feasibility, and outcomes of induced hypothermia therapy following in-hospital cardiac arrest-evaluation of a large prospective registry*." (2014). Maine Medical Center. 256.