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Published online: 2019-02-20
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Mild therapeutic hypothermia after out-of-hospital cardiac arrest: What does really matter?

Jakub Ratajczak, Piotr Łach, Julia Umińska, Krzysztof Pstrągowski, Michał Kasprzak, Tomasz Fabiszak, Eliano Pio Navarese, Jacek Kubica
DOI: 10.5603/CJ.a2019.0023
·
Pubmed: 30799547

open access

Ahead of print
Original articles
Published online: 2019-02-20

Abstract

Background: Mild therapeutic hypothermia (MTH) is a recommended treatment of comatose patients after out-of-hospital cardiac arrest (OHCA). The aim of the study was to examine determinants of clinical outcome in OHCA survivors treated with MTH and variables associated with MTH induction time.

Methods: Analysis of combined results from a retrospective and a prospective observational study including  90 OHCA survivors treated with MTH from January 2010 to March 2018. Multivariate regression analysis was performed to determine variables associated with poor neurologic outcome (Cerebral Performance Category 3-5), mortality, and prolonged induction time.

Results: At hospital discharge, 59 patients (65.6%) were alive, of whom 36 (61%) had good neurologic outcome. Older patients (OR 1.07, 95% confidence interval [CI] 1.03-1.12) with lower GCS (OR 0.49, 95%CI 0.30-0.80) were at higher risk of poor neurological outcome. The predictors of in-hospital death included: older age (OR 1.08, 95% CI 1.02-1.13), lower GCS score (OR 0.47, 95%CI 0.25-0.85), presence of cardiogenic shock (OR 3.43, 95%CI 1.11-10.53), and higher doses of adrenaline (OR 1.27, 95%CI 1.04-1.56). Longer induction was associated with shorter cardio-pulmonary resuscitation (CPR) [Unstandardised coefficient -3.95, 95%CI -7.09-(-0.81)] and lower lactate level [Unstandardised coefficient -18.55, 95%CI -36.10-(-1.01)].

Conclusions: Unfavorable neurologic outcome in OHCA patients treated with MTH is associated with age and lower GCS score. Risk factors for in-hospital mortality include age, high-dose adrenaline administration, lower GCS score and presence of cardiogenic shock. CPR duration and lactate level were predictive of prolonged MTH induction time.

Abstract

Background: Mild therapeutic hypothermia (MTH) is a recommended treatment of comatose patients after out-of-hospital cardiac arrest (OHCA). The aim of the study was to examine determinants of clinical outcome in OHCA survivors treated with MTH and variables associated with MTH induction time.

Methods: Analysis of combined results from a retrospective and a prospective observational study including  90 OHCA survivors treated with MTH from January 2010 to March 2018. Multivariate regression analysis was performed to determine variables associated with poor neurologic outcome (Cerebral Performance Category 3-5), mortality, and prolonged induction time.

Results: At hospital discharge, 59 patients (65.6%) were alive, of whom 36 (61%) had good neurologic outcome. Older patients (OR 1.07, 95% confidence interval [CI] 1.03-1.12) with lower GCS (OR 0.49, 95%CI 0.30-0.80) were at higher risk of poor neurological outcome. The predictors of in-hospital death included: older age (OR 1.08, 95% CI 1.02-1.13), lower GCS score (OR 0.47, 95%CI 0.25-0.85), presence of cardiogenic shock (OR 3.43, 95%CI 1.11-10.53), and higher doses of adrenaline (OR 1.27, 95%CI 1.04-1.56). Longer induction was associated with shorter cardio-pulmonary resuscitation (CPR) [Unstandardised coefficient -3.95, 95%CI -7.09-(-0.81)] and lower lactate level [Unstandardised coefficient -18.55, 95%CI -36.10-(-1.01)].

Conclusions: Unfavorable neurologic outcome in OHCA patients treated with MTH is associated with age and lower GCS score. Risk factors for in-hospital mortality include age, high-dose adrenaline administration, lower GCS score and presence of cardiogenic shock. CPR duration and lactate level were predictive of prolonged MTH induction time.

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Keywords

mild therapeutic hypothermia, MTH, targeted temperature management, OHCA

About this article
Title

Mild therapeutic hypothermia after out-of-hospital cardiac arrest: What does really matter?

Journal

Cardiology Journal

Issue

Ahead of print

Article type

Original Article

Published online

2019-02-20

DOI

10.5603/CJ.a2019.0023

Pubmed

30799547

Keywords

mild therapeutic hypothermia
MTH
targeted temperature management
OHCA

Authors

Jakub Ratajczak
Piotr Łach
Julia Umińska
Krzysztof Pstrągowski
Michał Kasprzak
Tomasz Fabiszak
Eliano Pio Navarese
Jacek Kubica

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