title: Therapeutic hypothermia for cardiac arrest: real-world utilization trends and hospital mortality.
abstract: BACKGROUND
  Therapeutic hypothermia (TH) improves outcomes following cardiac arrest in small clinical trials.
  
  
  OBJECTIVE
  To study real-world utilization and outcomes in US hospitals.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  California hospitals.
  
  
  METHODS
  Patients eligible for therapeutic hypothermia after cardiac arrest.
  
  
  METHODS
  We analyzed all discharges from California (1999-2008) to identify patients eligible for TH after cardiac arrest. Patients were considered eligible for TH if both cardiac arrest and anoxic brain injury were among the administrative diagnoses (n = 46,833). Patients undergoing TH (n = 204) were identified through billing codes.
  
  
  METHODS
  TH utilization and in-hospital mortality.
  
  
  RESULTS
  Use of TH increased over the study period with 87.3% (178/204) of TH occurring between 2006 and 2008. Few hospitals appeared to perform TH over the study period (47/419, 11.2%). Utilization of TH was concentrated in a few centers, with the top 3 of 419 centers accounting for 31.4% (64/204) of cases. Patients undergoing TH were younger, less likely to be male, more likely to be treated at teaching centers, and had similar comorbidities compared to eligible individuals who did not undergo TH. The adjusted odds ratio for hospital mortality among patients undergoing TH was 0.80 (95% confidence interval [CI] 0.60-1.06, P = 0.11).
  
  
  CONCLUSIONS
  TH utilization appears low, but implementation is increasing. Case selection and referral biases limit the analysis of the relationship between center TH volume and in-hospital mortality.
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, USA. jena@hcp.med.harvard.edu
authors.forename: Anupam B
authors.initials: AB
authors.lastname: Jena
authors.forename: John A
authors.initials: JA
authors.lastname: Romley
authors.forename: Christopher
authors.initials: C
authors.lastname: Newton-Cheh
authors.forename: Peter
authors.initials: P
authors.lastname: Noseworthy
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002140:California; D015897:Comorbidity; D005260:Female; D006323:Heart Arrest / Q000150:complications / Q000401:mortality* / Q000628:therapy*; D017052:Hospital Mortality; D006801:Humans; D007036:Hypothermia, Induced / Q000401:mortality* / Q000706:statistics & numerical data*; D002534:Hypoxia, Brain / Q000150:complications; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012189:Retrospective Studies; D012737:Sex Factors