title: Safety, feasibility, and outcomes of induced hypothermia therapy following in-hospital cardiac arrest-evaluation of a large prospective registry*.
abstract: OBJECTIVE
  Despite a lack of randomized trials, practice guidelines recommend that mild induced hypothermia be considered for comatose survivors of in-hospital cardiac arrest. This study describes the safety, feasibility, and outcomes of mild induced hypothermia treatment following in-hospital cardiac arrest.
  
  
  METHODS
  Prospective, observational, registry-based study.
  
  
  METHODS
  Forty-six critical care facilities in eight countries in Europe and the United States reporting in the Hypothermia Network Registry and the International Cardiac Arrest Registry.
  
  
  METHODS
  A total of 663 patients with in-hospital cardiac arrest and treated with mild induced hypothermia were included between January 2004 and February 2012.
  
  
  METHODS
  None.
  
  
  RESULTS
  A cerebral performance category of 1 or 2 was considered a good outcome. At hospital discharge 41% of patients had a good outcome. At median 6-month follow-up, 34% had a good outcome. Among in-hospital deaths, 52% were of cardiac causes and 44% of cerebral cause. A higher initial body temperature was associated with reduced odds of a good outcome (odds ratio, 0.79; 95% CI, 0.68-0.92). Adverse events were common; bleeding requiring transfusion (odds ratio, 0.56; 95% CI, 0.31-1.00) and sepsis (odds ratio, 0.52; 95% CI, 0.30-0.91) were associated with reduced odds for a good outcome.
  
  
  CONCLUSIONS
  In this registry study of an in-hospital cardiac arrest population treated with mild induced hypothermia, we found a 41% good outcome at hospital discharge and 34% at follow-up. Infectious complications occurred in 43% of cases, and 11% of patients required a transfusion for bleeding. The majority of deaths were of cardiac origin.
authors.affiliation: 1Department of Anaesthesiology and Intensive Care, Skåne University Hospital, Lund, Sweden. 2Department of Clinical Sciences, Lund University, Lund, Sweden. 3Department of Anaesthesiology and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden. 4Sarver Heart Center, University of Arizona, Tucson, AZ. 5Minneapolis Heart Institute Foundation, Abbot Northwestern Hospital, Minneapolis, MN. 6Department of Anesthesia and Intensive Care, Centre Hospitalier de Luxembourg, Luxembourg. 7Department of Critical Care Services and Neuroscience Institute, Maine Medical Center, Portland, ME. 8Department of Surgical Sciences/Anaesthesiology and Intensive Care, Uppsala University, Uppsala, Sweden. 9Department of Cardiology and Angiology, General University Hospital in Prague, Prague, Czech Republic. 10Surgical ICU Ullevål, Department of Anaesthesiology, Oslo University Hospital, Oslo, Norway. 11Department of Anaesthesiology and Intensive Care, Stavanger University Hospital, Stavanger, Norway. 12Department of Clinical Medicine, University of Bergen, Bergen, Norway.
authors.forename: Josef
authors.initials: J
authors.lastname: Dankiewicz
authors.forename: Simon
authors.initials: S
authors.lastname: Schmidbauer
authors.forename: Niklas
authors.initials: N
authors.lastname: Nielsen
authors.forename: Karl B
authors.initials: KB
authors.lastname: Kern
authors.forename: Michael R
authors.initials: MR
authors.lastname: Mooney
authors.forename: Pascal
authors.initials: P
authors.lastname: Stammet
authors.forename: Richard R
authors.initials: RR
authors.lastname: Riker
authors.forename: Sten
authors.initials: S
authors.lastname: Rubertsson
authors.forename: David
authors.initials: D
authors.lastname: Seder
authors.forename: Ondrej
authors.initials: O
authors.lastname: Smid
authors.forename: Kjetil
authors.initials: K
authors.lastname: Sunde
authors.forename: Eldar
authors.initials: E
authors.lastname: Søreide
authors.forename: Barbara T
authors.initials: BT
authors.lastname: Unger
authors.forename: Hans
authors.initials: H
authors.lastname: Friberg
mesh_terms: D000367:Age Factors; D000368:Aged; D001145:Arrhythmias, Cardiac; D001831:Body Temperature; D003128:Coma / Q000453:epidemiology*; D015897:Comorbidity; D003422:Critical Care / Q000379:methods; D005260:Female; D006305:Health Status Indicators; D006323:Heart Arrest / Q000150:complications* / Q000628:therapy*; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome