title: Endovascular cooling catheter related thrombosis in patients undergoing therapeutic hypothermia for out of hospital cardiac arrest.
abstract: BACKGROUND
  Therapeutic hypothermia improves neurologic outcome and survival in patients following out-of-hospital cardiac arrest (OHCA). Endovascular cooling devices are commonly used to rapidly achieve and maintain hypothermia. The use of these devices may be associated with catheter related thrombosis. The objective of this study was to determine the risk of catheter related thrombosis associated with the use of an endovascular cooling catheter in patients referred for therapeutic hypothermia following OHCA.
  
  
  RESULTS
  We conducted a retrospective cohort study on consecutive patients, referred for therapeutic hypothermia following OHCA, between February 2012 and May 2013. Of 80 patients initially treated with therapeutic hypothermia, 61 completed the cooling protocol using an endovascular cooling device. The primary outcome was catheter related thrombosis defined as evidence of thrombus in the inferior vena cava, deep vein thrombosis or pulmonary embolism during the index hospitalization. We further evaluated the incidence of the primary outcome between patients on dose adjusted intravenous unfractionated heparin compared to those on a subcutaneous prophylactic regimen alone. Catheter related thrombosis was observed in 9/61 (14.7%), with nine events in the prophylaxis group compared to none in the full dose unfractionated heparin group (22.0% vs. 0.0%, p=0.02).
  
  
  CONCLUSIONS
  The use of endovascular catheters for induction of therapeutic hypothermia is associated with a high rate of catheter related thrombosis. This risk appears to be abrogated with dose adjusted unfractionated heparin infusion.
authors: Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada.
authors: Ronnen
authors: R
authors: Maze
authors: Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada.
authors: Michel R
authors: MR
authors: Le May
authors: Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada.
authors: Michael
authors: M
authors: Froeschl
authors: Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada.
authors: Samir K
authors: SK
authors: Hazra
authors: Department of Medicine, Division of Hematology, University of Ottawa, Ottawa, ON, Canada.
authors: Philip S
authors: PS
authors: Wells
authors: Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada.
authors: Christina
authors: C
authors: Osborne
authors: Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada.
authors: Marino
authors: M
authors: Labinaz
authors: Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada.
authors: Benjamin
authors: B
authors: Hibbert
authors: Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada. Electronic address: dso@ottawaheart.ca.
authors: Derek Y F
authors: DY
authors: So
mesh_terms: D057785:Catheters / Q000009:adverse effects*; D015331:Cohort Studies; D057510:Endovascular Procedures / Q000295:instrumentation; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000628:therapy*; D012189:Retrospective Studies; D013927:Thrombosis / Q000209:etiology*
keywords: Cardiac arrest; Catheter related thrombosis; Therapeutic hypothermia