title: Efficacy of therapeutic hypothermia for neurological salvage in patients with cardiogenic sudden cardiac arrest: the importance of prehospital return of spontaneous circulation.
abstract: OBJECTIVE
  Cardiopulmonary resuscitation and mild therapeutic hypothermia (MTH) have improved neurological outcomes after sudden cardiac arrest, but the factors affecting favorable neurological outcome remain unclear. The aim of this study was to clarify these factors in patients in cardiac arrest treated with MTH.
  
  
  METHODS
  Forty-six consecutive patients (mean age, 59.4 ± 14.3 years; 37 men and 9 women) who had had cardiogenic cardiac arrest from January 2008 through December 2011, including cases that were and were not shockable, were enrolled in this study, and the factors affecting favorable neurological outcome were retrospectively investigated. The interval from cardiac arrest to cardiopulmonary resuscitation, the return of spontaneous circulation (ROSC), the start of MTH, and the attaining of the target temperature were retrieved from the medical records. The relationship between the neurological outcome and clinical findings, including the causes of cardiac arrest and vital signs before MTH, were also investigated.
  
  
  RESULTS
  Blood pressure and body temperature before MTH were higher, the interval from cardiac arrest to ROSC was shorter, and MTH was started earlier in patients with favorable neurological outcomes than in those with unfavorable outcomes. A multivariate logistic regression model revealed that the presence of prehospital ROSC was predictive of a favorable neurological outcome. In addition, renal failure during MTH occurred more frequently in patients with unfavorable neurological outcomes.
  
  
  CONCLUSIONS
  MTH is associated with favorable neurological outcomes after sudden cardiac arrest, including those with non-shockable rhythms, especially in patients with prehospital ROSC.
authors.affiliation: The Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, Japan.
authors.forename: Takuro
authors.initials: T
authors.lastname: Shinada
authors.forename: Noritake
authors.initials: N
authors.lastname: Hata
authors.forename: Nobuaki
authors.initials: N
authors.lastname: Kobayashi
authors.forename: Kazunori
authors.initials: K
authors.lastname: Tomita
authors.forename: Akihiro
authors.initials: A
authors.lastname: Shirakabe
authors.forename: Masafumi
authors.initials: M
authors.lastname: Tsurumi
authors.forename: Masato
authors.initials: M
authors.lastname: Matsushita
authors.forename: Hirotake
authors.initials: H
authors.lastname: Okazaki
authors.forename: Yoshiya
authors.initials: Y
authors.lastname: Yamamoto
authors.forename: Shinya
authors.initials: S
authors.lastname: Yokoyama
mesh_terms: D000368:Aged; D001794:Blood Pressure; D001833:Body Temperature Regulation; D016887:Cardiopulmonary Resuscitation / Q000009:adverse effects; D016009:Chi-Square Distribution; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced / Q000009:adverse effects; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009422:Nervous System Diseases / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D009460:Neurologic Examination; D058687:Out-of-Hospital Cardiac Arrest / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D051437:Renal Insufficiency / Q000209:etiology; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome