Outcome of Patients With Out of Hospital Cardiac Arrest Admitted to the Intensive Care Unit in an Inner City Hospital

Abstract

PURPOSE: Incidence of out-of-hospital cardiac arrest ranges from 92-189 cases/100,000 inhabitants; hospital mortality for those patients is 40%-90%. Several studies have shown improved survival and neurological outcome with mild therapeutic hypothermia (TH) in carefully selected patients after out-of-hospital cardiac arrest(CA). We evaluated mortality, discharge neurologic status, mechanical ventilator (MV) days and ICU and hospital length of stay (LOS) of patients with outof- hospital CA who met criteria for mild TH METHODS: Retrospective review of all patients admitted to ICU after out-ofhospital CA from July 2009 to January 2011. The decision to use TH was made using guidelines set forth by project hypothermia of the Greater New York Hospital Association and New York Fire Department RESULTS: 79 patients were identified during the study period; 34 patients received TH and 45 patients did not. Ventricular fibrillation(VF)accounted for 5(15%) in TH group compared to 10(22%) in normothermia group. Significant findings for patients in the TH group included; younger age (53.6vs62, P=0.007); less likely in shock (6versus19, P=0.02) Table 1. No differences were seen between the groups with respect to sex, race and location of cardiac arrest (community vs nursing home). Analysis of co-morbid conditions, Apache IV scores, initial EKG rhythm and requirement for MV revealed no different between the groups. The TH group had longer ICU LOS compared to non-hypothermia group (6.29+/-4.46 vs 3.73+/-3.81, P= 0.008) Mortality, neurologic outcome (cerebral performance category scale 1- 5), length of MV and hospital stay were similar in both the groups. Table 2. CONCLUSIONS: Contrary to published studies, implementation of TH in our innercity ICU did not show any benefit in mortality or neurological outcome when compared with the normothermia group. Patients with TH had greater ICU-LOS, but there was no difference in MV days or hospital LOS. CLINICAL IMPLICATIONS: Survival and neurological recovery seen in carefully selected patients in well controlled studies for VF-CA, are not evident when generalized criteria are used for implementation of TH. TH may not confer survival or neurological benefit in non-VF CA.