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Neurocritical Care
Published in: Neurocritical Care 1/2016

01-02-2016 | Original Article

Therapeutic Hypothermia After Resuscitation From a Non-Shockable Rhythm Improves Outcomes in a Regionalized System of Cardiac Arrest Care

Authors: Gene Sung, Nichole Bosson, Amy H. Kaji, Mark Eckstein, David Shavelle, William J. French, Joseph L. Thomas, William Koenig, James T. Niemann

Published in: Neurocritical Care | Issue 1/2016

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Abstract

Objective

Therapeutic hypothermia (TH) improves neurologic outcome in patients resuscitated from ventricular fibrillation. The purpose of this study was to evaluate TH effects on neurologic outcome in patients resuscitated from a non-shockable out-of-hospital cardiac arrest rhythm.

Design and Setting

This is a retrospective cohort study of data reported to a registry in an emergency medical system in a large metropolitan region. Patients achieving field return of spontaneous circulation are transported to designated hospitals with TH protocols.

Patients

Patients with an initial non-shockable rhythm were identified. Patients were excluded if awake in the Emergency Department or if TH was withheld due to preexisting coma or death prior to initiation. The decision to initiate TH was determined by the treating physician.

Measurements

The primary outcome was survival with good neurologic outcome defined by a cerebral performance category of 1 or 2.

Main Results

Of the 2772 patients treated for cardiac arrest during the study period, there were 1713 patients resuscitated from cardiac arrest with an initial non-shockable rhythm and 1432 patients met inclusion criteria. The median age was 69 years [IQR 59–82]; 802 (56 %) male. TH was induced in 596 (42 %) patients. Survival with good neurologic outcome was 14 % in the group receiving TH, compared with 5 % in those not treated with TH (risk difference = 8 %, 95 % CI 5–12 %). The adjusted OR for a CPC 1 or 2 with TH was 2.9 (95 % CI 1.9–4.4).

Conclusion

Analyzing the data collected from the registry of the standard practice in a large metropolitan region, TH is associated with improved neurologic outcome in patients resuscitated from initial non-shockable rhythms in a regionalized system for post-resuscitation care.
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Metadata
Title
Therapeutic Hypothermia After Resuscitation From a Non-Shockable Rhythm Improves Outcomes in a Regionalized System of Cardiac Arrest Care
Authors
Gene Sung
Nichole Bosson
Amy H. Kaji
Mark Eckstein
David Shavelle
William J. French
Joseph L. Thomas
William Koenig
James T. Niemann
Publication date
01-02-2016
Publisher
Springer US
Published in
Neurocritical Care / Issue 1/2016
Print ISSN: 1541-6933
Electronic ISSN: 1556-0961
DOI
https://doi.org/10.1007/s12028-015-0184-z

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