Survival effect after a therapeutic hypothermia protocol implementation

Abstract

OBJETIVE. To evaluate whether implementation of a therapeutic hypothermia (TH) protocol improved survival and neurologic outcomes in patients successfully resuscitated from cardiac arrest. METHOD AND PATIENTS. A Retrospective Historic Cohort Study realized in a Cardiac Intensive Care Unit from January 2007 to December 2010. An active cooling therapeutic hypothermia protocol, using a cooling surface method with hydrogel patches (Arctic Sun) to achieve a temperature of 33degreeC for 24 h was initiated on July 2009 for unconscious patients resuscitated from cardiac arrest. The device is connected to a temperature control console, measuring core temperature with an urinary catheter. In this study we compare patients who presented after implementation of a therapeutic hypothermia protocol with those who presented before the protocol was implemented. Demographics and outcomes were obtained from an intensive care medical database. RESULTS. A total of 81 consecutive adults, with nontraumatic cardiac arrest, admitted between January 2007 and December 2010 were included, 35 on TH group and 46 on control group. Both groups were similar with no statistic differences on personal previous medical history characteristics or cardiopulmonary resuscitation time. The only differences between groups was a greater number of patients with ventricular fibrillation (VF) as an initial rhythm and ECG changes in the TH group (72, 7%, p = 0.059), which results in a greater coronarography number (65.7%, p<0.001). Mortality at hospital discharge decreased in the therapeutic hypothermia group (p = 0.005, OR 0.154, 95% IC 0.043-0.546). In adjusted analysis, VF as an initial rhythm (p<0.05, OR 0.30, 95% confidence interval 0.096-0.96), short resuscitation time period (p = 0.02, OR 1.085, CI 1.013-1.162) and younger patients (p = 0.018, OR 1.055, CI 1.010-1.102) also result in a better survival. CONCLUSIONS. The implementation of a therapeutic hypothermia (TH) protocol was associated with a signific