title: Effectiveness of mild therapeutic hypothermia following cardiac arrest in adult patients with congenital heart disease.
abstract: Mild therapeutic hypothermia (TH) is an established therapy to improve survival and reduce neurologic injury after cardiac arrest. Adult patients with congenital heart disease (ACHD) are at increased risk of sudden cardiac death. The use of TH in this population has not been extensively studied. The aim of this study is to report our institutional experience using this treatment modality in patients with ACHD after cardiac arrest. We performed a retrospective observational study of a cohort of 245 consecutive patients treated with TH after cardiac arrest from 2007 to 2013. Five patients were identified as having complex ACHD with a mean age of 28 years. All were treated with TH according to an institutional protocol utilizing active surface cooling to maintain a core body temperature of 32°C to 34°C for 24 hours after cardiac arrest. Congenital lesions in these 5 patients included anomalous left coronary artery from the pulmonary artery; l-transposition of the great arteries; d-transposition of the great arteries status post atrial switch; unoperated tricuspid atresia, atrial septal defect, and ventricular septal defect with Eisenmenger's physiology; and surgically corrected atrial septal defect, cleft mitral valve, and subaortic membrane. All 5 patients suffered cardiac arrest due to ventricular arrhythmia and all survived to discharge without significant neurologic impairment. Therapeutic interventions included anomalous left coronary artery from the pulmonary artery ligation, percutaneous coronary intervention, and defibrillator implantation. In conclusion, in 5 patients with ACHD, the use of TH after cardiac arrest resulted in 100% survival to hospital discharge with good neurologic outcome postresuscitation.
authors.affiliation: Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee. Electronic address: michael.young@vanderbilt.edu.
authors.forename: Michael N
authors.initials: MN
authors.lastname: Young
authors.affiliation: Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Ryan D
authors.initials: RD
authors.lastname: Hollenbeck
authors.affiliation: Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Jeremy S
authors.initials: JS
authors.lastname: Pollock
authors.affiliation: Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: John A
authors.initials: JA
authors.lastname: McPherson
authors.affiliation: Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Fredi
authors.affiliation: Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Division of Adult Congenital Heart Disease, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Robert N
authors.initials: RN
authors.lastname: Piana
authors.affiliation: Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Division of Adult Congenital Heart Disease, Vanderbilt University Medical Center, Nashville, Tennessee; Division of Pediatric Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: May L
authors.initials: ML
authors.lastname: Mah
authors.affiliation: Division of Adult Congenital Heart Disease, Vanderbilt University Medical Center, Nashville, Tennessee; Division of Pediatric Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Frank A
authors.initials: FA
authors.lastname: Fish
authors.affiliation: Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Division of Adult Congenital Heart Disease, Vanderbilt University Medical Center, Nashville, Tennessee; Division of Pediatric Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Larry
authors.initials: L
authors.lastname: Markham
mesh_terms: D000328:Adult; D016757:Death, Sudden, Cardiac; D005260:Female; D006323:Heart Arrest / Q000628:therapy*; D006330:Heart Defects, Congenital / Q000150:complications*; D006801:Humans; D007036:Hypothermia, Induced; D008297:Male; D010351:Patient Discharge / Q000706:statistics & numerical data; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome