Early predictors of outcome in comatose survivors of ventricular fibrillation and non-ventricular fibrillation cardiac arrest treated with hypothermia: a prospective study.
OBJECTIVE
Current indications for therapeutic hypothermia (TH) are restricted to comatose patients with cardiac arrest (CA) due to ventricular fibrillation (VF) and without circulatory shock. Additional studies are needed to evaluate the benefit of this treatment in more heterogeneous groups of patients, including those with non-VF rhythms and/or shock and to identify early predictors of outcome in this setting.


METHODS
Prospective study, from December 2004 to October 2006.


METHODS
32-bed medico-surgical intensive care unit, university hospital.


METHODS
Comatose patients with out-of-hospital CA.


METHODS
TH to 33 +/- 1 degrees C (external cooling, 24 hrs) was administered to patients resuscitated from CA due to VF and non-VF (including asystole or pulseless electrical activity), independently from the presence of shock.


RESULTS
We hypothesized that simple clinical criteria available on hospital admission (initial arrest rhythm, duration of CA, and presence of shock) might help to identify patients who eventually survive and might most benefit from TH. For this purpose, outcome was related to these predefined variables. Seventy-four patients (VF 38, non-VF 36) were included; 46% had circulatory shock. Median duration of CA (time from collapse to return of spontaneous circulation [ROSC]) was 25 mins. Overall survival was 39.2%. However, only 3.1% of patients with time to ROSC > 25 mins survived, as compared to 65.7% with time to ROSC < or = 25 mins. Using a logistic regression analysis, time from collapse to ROSC, but not initial arrest rhythm or presence of shock, independently predicted survival at hospital discharge.


CONCLUSIONS
Time from collapse to ROSC is strongly associated with outcome following VF and non-VF cardiac arrest treated with therapeutic hypothermia and could therefore be helpful to identify patients who benefit most from active induced cooling.
Oddo
Mauro
M
Department of Critical Care Medicine, Lausanne University Medical Center and Faculty of Biology and Medicine, Lausanne, Switzerland. Mauro.Oddo@chuv.ch
Ribordy
Vincent
V
Feihl
François
F
Rossetti
Andrea O
AO
Schaller
Marie-Denise
MD
Chioléro
René
R
Liaudet
Lucas
L
D000368:Aged; D003128:Coma / Q000150:complications / Q000628:therapy*; D005260:Female; D006323:Heart Arrest / Q000150:complications / Q000209:etiology* / Q000628:therapy*; D017052:Hospital Mortality; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D007362:Intensive Care Units; D007773:Lactates / Q000097:blood; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012151:Resuscitation / Q000379:methods; D016019:Survival Analysis; D013997:Time Factors; D014693:Ventricular Fibrillation / Q000150:complications*
D007773:Lactates