title: Electrocardiographic changes during therapeutic hypothermia.
abstract: OBJECTIVE
  Induced mild therapeutic hypothermia (MTH) is an effective treatment to improve outcome after out-of-hospital resuscitation. Adverse events are rare, but arrhythmias and bleeding complications have been reported. So far, only few data about electrocardiographic changes and associated events have been reported.
  
  
  METHODS
  Between 6/2005 and 3/2011, 109 comatose survivors of out-of-hospital cardiac arrest admitted to our institution underwent MTH. In an observational single-center study, we analyzed preclinical course, electrocardiographic changes, arrhythmias, laboratory parameters and complication rates before, during and after MTH.
  
  
  RESULTS
  MTH led to a significant decrease of heart rate (85.0±23.3 min(-1) at admission; 59.1±20.5 min(-1) during, p<0.01 and 63.1±19.2 after hypothermia p<0.05) a significant prolongation of PR (0.17±0.04 s before, 0.18±0.05 s during, p<0.05; and 0.17±0.04 s after hypothermia, p<0.01) and QTc intervals (0.47±0.05 s before, 0.49±0.05 s during, p<0.01; and 0.46±0.05 s after hypothermia, p<0.01). Two patients developed ventricular fibrillation during hypothermia, both had an acute myocardial infarction. No significant MTH related changes in electrolytes or coagulation parameters were observed. Major bleeding complications occurred in four cases (3.7%) with a trend towards more bleedings after use of preclinical thrombolysis (21.4% with to 6.4% without thrombolysis, p=0.057). We did not find increased risk for bleeding complications in patients with double platelet inhibition after PCI (14.3% compared to 9.5% without PCI, p=0.63) compared to those without PCI.
  
  
  CONCLUSIONS
  Under strict clinical and laboratory parameter control, induced mild therapeutic hypothermia can be applied to most patients after out-of-hospital cardiac arrest with no increased risk for arrhythmias despite significant electrocardiographic changes.
authors: Department of Cardiology and Angiology, University Hospital of Muenster, Muenster, Germany. pia.lebiedz@ukmuenster.de
authors: Pia
authors: P
authors: Lebiedz
authors: Jan
authors: J
authors: Meiners
authors: Alexander
authors: A
authors: Samol
authors: Kristina
authors: K
authors: Wasmer
authors: Holger
authors: H
authors: Reinecke
authors: Johannes
authors: J
authors: Waltenberger
authors: Lars
authors: L
authors: Eckardt
mesh_terms: D000328:Adult; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000209:etiology* / Q000628:therapy; D016887:Cardiopulmonary Resuscitation / Q000009:adverse effects*; D004562:Electrocardiography; D005260:Female; D006339:Heart Rate; D006801:Humans; D007036:Hypothermia, Induced / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome