title: Postresuscitation care with mild therapeutic hypothermia and coronary intervention after out-of-hospital cardiopulmonary resuscitation: a prospective registry analysis.
abstract: BACKGROUND
  Mild therapeutic hypothermia (MTH) has been shown to result in better neurological outcome after cardiopulmonary resuscitation. Percutaneous coronary intervention (PCI) may also be beneficial in patients after out-of-hospital cardiac arrest (OHCA).
  
  
  METHODS
  A selected cohort study of 2,973 prospectively documented adult OHCA patients within the German Resuscitation Registry between 2004 and 2010. Data were analyzed by backwards stepwise binary logistic regression to identify the impact of MTH and PCI on both 24-hour survival and neurological outcome that was based on cerebral performance category (CPC) at hospital discharge. Odds ratios (95% confidence intervals) were calculated adjusted for the following confounding factors: age, location of cardiac arrest, presumed etiology, bystander cardiopulmonary resuscitation, witnessing, first electrocardiogram rhythm, and thrombolysis.
  
  
  RESULTS
  The Preclinical care dataset included 2,973 OHCA patients with 44% initial return of spontaneous circulation (n = 1,302) and 35% hospital admissions (n = 1,040). Seven hundred and eleven out of these 1,040 OHCA patients (68%) were also registered within the Postresuscitation care dataset. Checking for completeness of datasets required the exclusion of 127 Postresuscitation care cases, leaving 584 patients with complete data for final analysis. In patients without PCI (n = 430), MTH was associated with increased 24-hour survival (8.24 (4.24 to 16.0), P < 0.001) and the proportion of patients with CPC 1 or CPC 2 at hospital discharge (2.13 (1.17 to 3.90), P < 0.05) as an independent factor. In normothermic patients (n = 405), PCI was independently associated with increased 24-hour survival (4.46 (2.26 to 8.81), P < 0.001) and CPC 1 or CPC 2 (10.81 (5.86 to 19.93), P < 0.001). Additional analysis of all patients (n = 584) revealed that 24-hour survival was increased by MTH (7.50 (4.12 to 13.65), P < 0.001) and PCI (3.88 (2.11 to 7.13), P < 0.001), while the proportion of patients with CPC 1 or CPC 2 was significantly increased by PCI (5.66 (3.54 to 9.03), P < 0.001) but not by MTH (1.27 (0.79 to 2.03), P = 0.33), although an unadjusted Fisher exact test suggested a significant effect of MTH (unadjusted odds ratio 1.83 (1.23 to 2.74), P < 0.05).
  
  
  CONCLUSIONS
  PCI may be an independent predictor for good neurological outcome (CPC 1 or CPC 2) at hospital discharge. MTH was associated with better neurological outcome, although subsequent logistic regression analysis did not show statistical significance for MTH as an independent predictor for good neurological outcome. Thus, postresuscitation care on the basis of standardized protocols including coronary intervention and hypothermia may be beneficial after successful resuscitation. One of the main limitations may be a selection bias for patients subjected to PCI and MTH.
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Schwanenweg 21, Kiel 24105, Germany. graesner@anaesthesie.uni-kiel.de
authors.forename: Jan Thorsten
authors.initials: JT
authors.lastname: Gräsner
authors.forename: Patrick
authors.initials: P
authors.lastname: Meybohm
authors.forename: Amke
authors.initials: A
authors.lastname: Caliebe
authors.forename: Bernd W
authors.initials: BW
authors.lastname: Böttiger
authors.forename: Jan
authors.initials: J
authors.lastname: Wnent
authors.forename: Martin
authors.initials: M
authors.lastname: Messelken
authors.forename: Tanja
authors.initials: T
authors.lastname: Jantzen
authors.forename: Thorsten
authors.initials: T
authors.lastname: Zeng
authors.forename: Bernd
authors.initials: B
authors.lastname: Strickmann
authors.forename: Andreas
authors.initials: A
authors.lastname: Bohn
authors.forename: Hans
authors.initials: H
authors.lastname: Fischer
authors.forename: Jens
authors.initials: J
authors.lastname: Scholz
authors.forename: Matthias
authors.initials: M
authors.lastname: Fischer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D016887:Cardiopulmonary Resuscitation; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality / Q000628:therapy*; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D016019:Survival Analysis; D016896:Treatment Outcome