Therapeutic hypothermia in comatose patients after out-of-hospital cardiac arrest.
Our intensive care unit has been treating comatose patients, following an out-of-hospital cardiac arrest, with therapeutic hypothermia since 2002. In all, 139 out-of-hospital cardiac arrest patients were admitted in the 4-year period 2002-5. Of these, 27% had a favourable outcome (discharged home or to rehabilitation). Forty-one per cent of patients presenting with ventricular fibrillation (VF) and 7% of non-VF patients had a favourable outcome. No patient with an estimated time from collapse to first attempt at cardiopulmonary resuscitation over 12 min survived to hospital discharge. Twenty-two per cent of patients over 70 years were discharged home, suggesting age was not a barrier to surviving out-of-hospital cardiac arrest. The introduction of a therapeutic hypothermia clinical pathway, at the end of 2003 improved the efficiency of cooling. The percentage of patients cooled to below 34 degrees C within 4 h increased from 15 to 51% and those cooled for more than 12 h increased from 30 to 83%.
Hay
A W
AW
Critical Care, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SB, UK. alasdairwhay@gmail.com <alasdairwhay@gmail.com>
Swann
D G
DG
Bell
K
K
Walsh
T S
TS
Cook
B
B
D018806:APACHE; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002986:Clinical Trials as Topic; D003128:Coma / Q000209:etiology / Q000628:therapy*; D003422:Critical Care / Q000379:methods*; D019091:Critical Pathways; D003953:Diagnosis-Related Groups; D005260:Female; D006323:Heart Arrest / Q000150:complications / Q000628:therapy*; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome