The implementation of therapeutic hypothermia in the emergency department: a multi-institution case review.
BACKGROUND
The use of therapeutic hypothermia (TH) is a burgeoning treatment modality for post-cardiac arrest patients.


OBJECTIVE
We performed a retrospective chart review of patients who underwent post-cardiac arrest TH at eight different institutions across the United States. Our objectives were to assess how TH is currently being implemented in emergency departments and to examine the feasibility of conducting TH research using multi-institution prospective data.


METHODS
A total of 94 cases were identified in a 3-year period and submitted for review by participating institutions of the Peri-Resuscitation Consortium. Of those, seven charts were excluded for missing data. Two independent reviewers performed the data abstraction. Results were subsequently compared, and discrepancies were resolved by a third reviewer. We assessed patient demographics, initial presenting rhythm, time until TH initiation, duration of TH, cooling methods and temperature reached, survival to hospital discharge, and neurological status on discharged.


RESULTS
The majority of cases had initial cardiac rhythms of asystole or pulseless electrical activity (55.2%), followed by ventricular tachycardia or fibrillation (34.5%). The inciting cardiac rhythm was unknown in 10.3% of cases. Time to initiation of TH ranged from 0 to 783 minutes with a mean time of 99 minutes (SD=132). Length of TH ranged from 25 to 2,171 minutes with a mean time of 1,191 minutes (SD=536). The average minimum temperature achieved was 32.5°C, with a range from 27.6°C to 36.7°C (SD=1.5°C). Of the 87 charts reviewed, 29 (33.3%) of the patients survived to hospital discharge.


CONCLUSIONS
The implementation of TH across the country is extremely varied with no universally accepted treatment. While our study is limited by sample size, it illustrates some compelling trends. A large, prospective, multicenter trial or registry is necessary to elucidate further the optimal parameters for TH and its benefit in various population subsets.
1 Keck School of Medicine of the University of Southern California , Los Angeles, California.
Daniel
D
Joseph
Sara W
SW
Johnson
Melissa
M
Joseph
Dina
D
Seif
Meena
M
Zareh
David
D
Barnes
Adrian
A
Elliot
Erik
E
Kochert
Christine
C
Kulstad
Mike
M
Nelson
Christine
C
Riguzzi
David
D
Slattery
Sean O
SO
Henderson