Outcomes of mild therapeutic hypothermia after in-hospital cardiac arrest.
BACKGROUND
Although the benefits of mild therapeutic hypothermia (MTH) in selected patients after out-of-hospital cardiac arrest have been consistently demonstrated, no controlled trial of MTH in selected patients after in-hospital cardiac arrest (IHCA) has been published. We sought to assess the benefit of MTH after IHCA in patients meeting our institutions IHCA MTH inclusion criteria.


METHODS
A retrospective, historical control study was performed. During the 3-year period before and after the 2006 MTH protocol implementation at our institution, we identified a total of 118 patients admitted to our Medical Intensive Care Unit after resuscitation from an IHCA. Two blinded investigators identified all patients meeting our institutions MTH protocol inclusion criteria and the patients in each time period were compared. The primary outcome was discharge with good neurological function.


RESULTS
33 IHCA patients met MTH protocol inclusion criteria; 16 patients were admitted prior to MTH protocol implementation and thus were not treated with MTH post arrest while 17 patients were admitted after implementation and were all treated with MTH post arrest. 91% of patients had an arrest rhythm of asystole or pulseless electrical activity. Good neurological function at discharge was found in 24% of MTH patients and 31% of controls (P = .62).


CONCLUSIONS
No difference in neurological outcome at discharge was detected in predominantly non-shockable IHCA patients treated with MTH. This finding, if confirmed with further study, may define a population of patients for whom this costly and resource intensive therapy should be withheld.
Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Medical Center, New York, NY, USA. pkory@chpnet.org
Pierre
P
Kory
Mayuko
M
Fukunaga
Joseph P
JP
Mathew
Bimaljeet
B
Singh
Lisa
L
Szainwald
Joseph
J
Mosak
Mathew
M
Marks
Dana
D
Berg
Meir
M
Saadia
Annie
A
Katz
Paul H
PH
Mayo
D000368:Aged; D001927:Brain Diseases / Q000517:prevention & control*; D016887:Cardiopulmonary Resuscitation; D003422:Critical Care / Q000379:methods*; D005260:Female; D006323:Heart Arrest / Q000628:therapy*; D006760:Hospitalization; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D007297:Inpatients; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D012189:Retrospective Studies; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000628:therapy