title: Therapeutic hypothermia is associated with improved neurologic outcome and survival in cardiac arrest survivors of non-shockable rhythms.
abstract: BACKGROUND
  Therapeutic hypothermia improves neurologic outcomes in patients resuscitated from cardiac arrest due to ventricular fibrillation. However, its role in patients with cardiac arrest due to non-shockable rhythms (pulseless electrical activity (PEA) and asystole) is unclear. We hypothesized that therapeutic hypothermia favorably impacts neurologic outcome and survival in patients resuscitated from cardiac arrest due to non-shockable rhythms.
  
  
  METHODS
  Retrospectively collected data on consecutive adult patients admitted to Hartford Hospital from 1/1/2004 to 11/1/2010 who survived a cardiac arrest due to PEA or asystole were analyzed. Patients who underwent therapeutic hypothermia (1/1/2007-11/1/2010) formed the hypothermia group while patients admitted prior to the institution of therapeutic hypothermia (1/1/2004-1/1/2007) at Hartford Hospital formed the control group. The primary end-point was measured using the Pittsburgh cerebral performance category (CPC) scale and patients were assessed for a good (CPC 1 and 2) or poor (CPC 3-5) neurological outcome prior to discharge from hospital. A secondary end-point was measured as survival at discharge from hospital.
  
  
  RESULTS
  Of 100 post-cardiac arrest patients included in the study, 15/52 (29%) patients in the hypothermia group had a good neurologic outcome as compared to 5/43 (10%) patients in the control group (P=0.021). On multivariate analysis, the odds ratio for good neurologic outcome and survival at discharge from the hospital with therapeutic hypothermia as compared to control were 4.35 (95% CI 1.10-17.24, P=0.04) and 5.65 (CI 1.66-19.23, P=0.006) respectively.
  
  
  CONCLUSIONS
  Therapeutic hypothermia is associated with favorable neurologic outcome and survival in patients resuscitated after cardiac arrest due to non-shockable rhythms.
authors.affiliation: Division of Cardiology, Hartford Hospital, Hartford, CT, United States. Jlundby@harthosp.org
authors.forename: Justin B
authors.initials: JB
authors.lastname: Lundbye
authors.forename: Mridula
authors.initials: M
authors.lastname: Rai
authors.forename: Bhavadharini
authors.initials: B
authors.lastname: Ramu
authors.forename: Alireza
authors.initials: A
authors.lastname: Hosseini-Khalili
authors.forename: Dadong
authors.initials: D
authors.lastname: Li
authors.forename: Hanna B
authors.initials: HB
authors.lastname: Slim
authors.forename: Sanjeev P
authors.initials: SP
authors.lastname: Bhavnani
authors.forename: Sanjeev U
authors.initials: SU
authors.lastname: Nair
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Kluger
mesh_terms: D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D003128:Coma / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006323:Heart Arrest / Q000150:complications / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D017741:Survivors / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology