title: Outcomes in Cardiac Arrest Patients due to Toxic Exposure Treated with Therapeutic Hypothermia.
abstract: The incidence and outcome of patients who undergo therapeutic hypothermia (TH) after toxin-induced cardiac arrest (TICA) is not previously described. Our study aimed to describe the incidence, epidemiologic characteristics, and outcomes of patients who experience TICA in a dedicated clinical pathway for post-cardiac arrest care between November 2007 and February 2013. All patients were treated in an evidence-based clinical pathway that included TH. Database and medical records were independently reviewed by investigators to ascertain TICA. TICA was defined as cardiac arrest (CA) directly and immediately caused by a xenobiotic exposure. All patients were enrolled at Carolinas Medical Center, an urban 874-bed teaching hospital that serves as a regional cardiac resuscitation center. All patients were adult victims of cardiac arrest who had obtained return of spontaneous circulation and were enrolled in a clinical pathway for post-cardiac arrest care that included TH. Three hundred eighty-nine patients underwent treatment following CA during the study period and 48 (12 %) were deemed TICA. Patients who suffered TICA were slightly younger, less likely to have an initial shockable rhythm, and less likely to receive bystander CPR as compared to non-toxic cases. TICA accounted for a significant proportion of patients in this study. Additional, larger studies are needed to fully elucidate the optimal role for TH in TICA.
authors: Department of Pulmonary and Critical Care Medicine, MedStar Washington Hospital Center, 110 Irving Street NW, 2A-68B, Washington, DC, 20010, USA. katharine.modisett@gmail.com.
authors: Katharine L
authors: KL
authors: Modisett
authors: Division of Medical Toxicology, Department of Emergency Medicine, Einstein Medical Center, Korman Research Building, Suite B-9, 5501 Old York Road, Philadelphia, PA, 19141, USA.
authors: Steven J
authors: SJ
authors: Walsh
authors: Department of Emergency Medicine, Department of Internal Medicine, Division of Critical Care Medicine, Carolinas Medical Center, 1000 Blythe Blvd, Charlotte, NC, 28203, USA.
authors: Alan C
authors: AC
authors: Heffner
authors: Department of Emergency Medicine, Carolinas Medical Center, 1000 Blythe Blvd, Charlotte, NC, 28203, USA.
authors: David A
authors: DA
authors: Pearson
authors: Department of Emergency Medicine, Division of Medical Toxicology, Carolinas Medical Center, 1000 Blythe Blvd, Charlotte, NC, 28203, USA.
authors: William
authors: W
authors: Kerns
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000506:poisoning / Q000633:toxicity; D001569:Benzodiazepines / Q000506:poisoning; D054715:Cardiotoxins / Q000633:toxicity*; D003042:Cocaine / Q000633:toxicity; D003131:Combined Modality Therapy / Q000009:adverse effects; D005260:Female; D006323:Heart Arrest / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control / Q000628:therapy*; D006784:Hospitals, Teaching; D006801:Humans; D007036:Hypothermia, Induced / Q000009:adverse effects*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D011041:Poisoning / Q000453:epidemiology / Q000503:physiopathology*; D012042:Registries; D012189:Retrospective Studies; D055502:Secondary Prevention; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D054715:Cardiotoxins; D001569:Benzodiazepines; D003042:Cocaine
keywords: Cardiac arrest; Therapeutic hypothermia; Toxic ingestion