Safety, feasibility, and outcomes of induced hypothermia therapy following in-hospital cardiac arrest-evaluation of a large Prospective registry

Josef Dankiewicz, Simon Schmidbauer, Niklas Nielsen, Karl B Kern, Michael R. Mooney, Pascal Stammet, Richard R. Riker, Sten Rubertsson, David Seder, Ondrej Smid, Kjetil Sunde, Eldar Søreide, Barbara T. Unger, Hans Friberg

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Objectives: 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. Design: Prospective, observational, registry-based study. Setting: 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. Patients: A total of 663 patients with in-hospital cardiac arrest and treated with mild induced hypothermia were included between January 2004 and February 2012. Interventions: None. Measurements and Main 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 followup, 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.

Original languageEnglish (US)
Pages (from-to)2537-2545
Number of pages9
JournalCritical Care Medicine
Volume42
Issue number12
DOIs
StatePublished - 2014

Fingerprint

Induced Hypothermia
Heart Arrest
Registries
Safety
Odds Ratio
Therapeutics
Hemorrhage
Patient Discharge
Critical Care
Coma
Hypothermia
Body Temperature
Practice Guidelines
Survivors
Sepsis
Population

Keywords

  • Adverse events
  • Heart arrest
  • In-hospital
  • Induced hypothermia
  • Interventions
  • Mortality
  • Outcome

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Medicine(all)

Cite this

Safety, feasibility, and outcomes of induced hypothermia therapy following in-hospital cardiac arrest-evaluation of a large Prospective registry. / Dankiewicz, Josef; Schmidbauer, Simon; Nielsen, Niklas; Kern, Karl B; Mooney, Michael R.; Stammet, Pascal; Riker, Richard R.; Rubertsson, Sten; Seder, David; Smid, Ondrej; Sunde, Kjetil; Søreide, Eldar; Unger, Barbara T.; Friberg, Hans.

In: Critical Care Medicine, Vol. 42, No. 12, 2014, p. 2537-2545.

Research output: Contribution to journalArticle

Dankiewicz, J, Schmidbauer, S, Nielsen, N, Kern, KB, Mooney, MR, Stammet, P, Riker, RR, Rubertsson, S, Seder, D, Smid, O, Sunde, K, Søreide, E, Unger, BT & Friberg, H 2014, 'Safety, feasibility, and outcomes of induced hypothermia therapy following in-hospital cardiac arrest-evaluation of a large Prospective registry', Critical Care Medicine, vol. 42, no. 12, pp. 2537-2545. https://doi.org/10.1097/CCM.0000000000000543
Dankiewicz, Josef ; Schmidbauer, Simon ; Nielsen, Niklas ; Kern, Karl B ; Mooney, Michael R. ; Stammet, Pascal ; Riker, Richard R. ; Rubertsson, Sten ; Seder, David ; Smid, Ondrej ; Sunde, Kjetil ; Søreide, Eldar ; Unger, Barbara T. ; Friberg, Hans. / Safety, feasibility, and outcomes of induced hypothermia therapy following in-hospital cardiac arrest-evaluation of a large Prospective registry. In: Critical Care Medicine. 2014 ; Vol. 42, No. 12. pp. 2537-2545.
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abstract = "Objectives: 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. Design: Prospective, observational, registry-based study. Setting: 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. Patients: A total of 663 patients with in-hospital cardiac arrest and treated with mild induced hypothermia were included between January 2004 and February 2012. Interventions: None. Measurements and Main 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 followup, 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.",
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AU - Dankiewicz, Josef

AU - Schmidbauer, Simon

AU - Nielsen, Niklas

AU - Kern, Karl B

AU - Mooney, Michael R.

AU - Stammet, Pascal

AU - Riker, Richard R.

AU - Rubertsson, Sten

AU - Seder, David

AU - Smid, Ondrej

AU - Sunde, Kjetil

AU - Søreide, Eldar

AU - Unger, Barbara T.

AU - Friberg, Hans

PY - 2014

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N2 - Objectives: 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. Design: Prospective, observational, registry-based study. Setting: 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. Patients: A total of 663 patients with in-hospital cardiac arrest and treated with mild induced hypothermia were included between January 2004 and February 2012. Interventions: None. Measurements and Main 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 followup, 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.

AB - Objectives: 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. Design: Prospective, observational, registry-based study. Setting: 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. Patients: A total of 663 patients with in-hospital cardiac arrest and treated with mild induced hypothermia were included between January 2004 and February 2012. Interventions: None. Measurements and Main 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 followup, 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.

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KW - Heart arrest

KW - In-hospital

KW - Induced hypothermia

KW - Interventions

KW - Mortality

KW - Outcome

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