Community-based application of mild therapeutic hypothermia for survivors of cardiac arrest.
OBJECTIVE
To demonstrate that the application of therapeutic hypothermia is technically feasible in a community-based setting.


BACKGROUND
Implementation of therapeutic hypothermia for survivors of cardiac arrest in the United States has been slow, at least partially because of the perception that this therapy is technically difficult, especially at the community level.


METHODS
Retrospective cohort study with historical controls.


METHODS
At our three community hospitals and after return of spontaneous circulation (ROSC), survivors of cardiac arrest were treated with therapeutic hypothermia using ice and cooling blankets or suits in order to cool patients to 32 degrees C-34 degrees C within 4 hours to achieve goal temperature within 8 hours and to maintain goal temperature for 24 hours.


RESULTS
Beginning in 2004, 44 survivors of cardiac arrest were managed with therapeutic hypothermia. The mean time from ROSC to initiation of therapeutic hypothermia was 2.8 hours (range, 0.2-7.8 hours), the mean time from ROSC to goal temperature was 7.2 hours (range, 0.8-15.1 hours), and the mean time maintained at goal temperature was 24.5 hours (range, 9-28 hours). Once patients achieved goal temperature, 4.4% of the temperature readings were above 34 degrees C, reflecting undercooling, while 16.4% of the readings were below 32 degrees C, indicative of overcooling. Overall survival until hospital discharge with good neurologic outcome was 43%, compared to only 13% (P < 0.001) among selected controls. There were no major complications directly attributable to the induction of hypothermia or rewarming.


CONCLUSIONS
A simple protocol of mild therapeutic hypothermia using locally available resources is technically feasible and safe in a community-based setting.
Prior
John
J
Department of Medicine, Mercy Hospital, Commonwealth Medical College, Scranton, PA, USA. JPrior@tcmedc.org
Lawhon-Triano
Mary
M
Fedor
David
D
Vanston
Vincent J
VJ
Getts
Roger
R
Smego
Raymond A
RA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000534:rehabilitation*; D016887:Cardiopulmonary Resuscitation; D015331:Cohort Studies; D005240:Feasibility Studies; D005260:Female; D006323:Heart Arrest / Q000628:therapy*; D006764:Hospitals, Community; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D012189:Retrospective Studies; D055815:Young Adult