title: Effect of therapeutic hypothermia on the outcomes after out-of-hospital cardiac arrest according to initial ECG rhythm and witnessed status: A nationwide observational interaction analysis.
abstract: BACKGROUND
  The use of mild therapeutic hypothermia (TH) in out-of-hospital cardiac arrest (OHCA) with shockable rhythms is recommended and widely used. However, it is unclear whether TH is associated with better outcomes in non-shockable rhythms.
  
  
  METHODS
  This is a retrospective observational study using a national OHCA cohort database composed of emergency medical services (EMS) and hospital data. We included adult EMS-treated OHCA patients of presumed cardiac etiology who were admitted to the hospital during Jan. 2008 to Dec. 2013. Patients without hospital outcome data were excluded. The primary outcome was good neurological outcome at discharge; secondary outcome was survival to discharge. The primary exposure was TH. We compared outcomes between TH and non-TH groups using multivariable logistic regression, adjusting for individual and Utstein factors. Interactions of initial ECG rhythm and witnessed status on the effect of TH on outcomes were tested.
  
  
  RESULTS
  There were 11,256 patients in the final analysis. TH was performed in 1703 patients (15.1%). Neurological outcome was better in TH (23.5%) than non-TH (15.0%) (Adjusted OR=1.25, 95% CI 1.05-1.48). The effect of TH on the odds for good neurological outcome was highest in the witnessed PEA group (Adjusted OR=3.91, 95% CI 1.87-8.14). Survival to discharge was significantly higher in the TH group (55.1%) than non-TH (35.9%) (Adjusted OR=1.76, 95% CI 1.56-2.00).
  
  
  CONCLUSIONS
  In a nationwide observational study, TH is associated with better neurological outcome and higher survival to discharge. The effect of TH is greatest in witnessed OHCA patients with PEA as the initial ECG rhythm.
authors.affiliation: Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Laboratory, Republic of Korea. Electronic address: saewonchoi@gmail.com.
authors.forename: Sae Won
authors.initials: SW
authors.lastname: Choi
authors.affiliation: Department of Emergency Medicine, Seoul National University College of Medicine, Republic of Korea. Electronic address: shinsangdo@medimail.co.kr.
authors.forename: Sang Do
authors.initials: SD
authors.lastname: Shin
authors.affiliation: Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Republic of Korea. Electronic address: Ro.youngsun@gmail.com.
authors.forename: Young Sun
authors.initials: YS
authors.lastname: Ro
authors.affiliation: Department of Emergency Medicine, Seoul National University College of Medicine, Republic of Korea. Electronic address: skciva@gmail.com.
authors.forename: Kyoung Jun
authors.initials: KJ
authors.lastname: Song
authors.affiliation: Department of Emergency Medicine, Seoul National University Hospital, Republic of Korea. Electronic address: ironlyj@gmail.com.
authors.forename: Eui Jung
authors.initials: EJ
authors.lastname: Lee
authors.affiliation: Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Republic of Korea. Electronic address: arendt75@gmail.com.
authors.forename: Ki Ok
authors.initials: KO
authors.lastname: Ahn
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation; D016208:Databases, Factual; D004562:Electrocardiography / Q000379:methods*; D004632:Emergency Medical Services; D005260:Female; D006761:Hospitals; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000628:therapy*; D010351:Patient Discharge; D012042:Registries; D056910:Republic of Korea; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
keywords: ECG rhythm; Out of hospital cardiac arrest; Outcomes; Therapeutic hypothermia