title: Early predictors of outcome in comatose survivors of ventricular fibrillation and non-ventricular fibrillation cardiac arrest treated with hypothermia: a prospective study.
abstract: 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.
authors.affiliation: Department of Critical Care Medicine, Lausanne University Medical Center and Faculty of Biology and Medicine, Lausanne, Switzerland. Mauro.Oddo@chuv.ch
authors.forename: Mauro
authors.initials: M
authors.lastname: Oddo
authors.forename: Vincent
authors.initials: V
authors.lastname: Ribordy
authors.forename: François
authors.initials: F
authors.lastname: Feihl
authors.forename: Andrea O
authors.initials: AO
authors.lastname: Rossetti
authors.forename: Marie-Denise
authors.initials: MD
authors.lastname: Schaller
authors.forename: René
authors.initials: R
authors.lastname: Chioléro
authors.forename: Lucas
authors.initials: L
authors.lastname: Liaudet
mesh_terms: 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*
chemical_list: D007773:Lactates