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

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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.

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

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Keywords

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

ASJC Scopus subject areas

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

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