Therapeutic hypothermia after non‑traumatic cardiac arrest for 12 hours: Hospital Karlovy Vary from 2006 to 2009

Czech version

Authors: R. Sýkora; R. Janda
Authors‘ workplace: Anesteziologicko‑resuscitační oddělení nemocnice v Karlových Varech, Karlovarská krajská nemocnice, a. s., přednosta prim. MU Dr. Roman Brázdil
Published in: Vnitř Lék 2011; 57(1): 72-77
Category: Original Contributions

Overview

Introduction and aims:
Therapeutic hypothermia is a standard part of post-resuscitation care. Here we present cohort patients after non-traumatic cardiac arrest and their neurological outcomes who underwent 12 hours of therapeutic hypothermia. Moreover, we focused on examining the results of particular subgroup of patients with initial ventricular fibrillation (VF) with acute myocardial infarction with ST-elevation (STEMI) who underwent coronary intervention (PCI).

Methods:
We evaluated retrospectively the patients with non-traumatic out- of- and in-hospital cardiac arrest (IHCA, OHCA), admitted to our intensive care unit (ICU) in 2006– 2009. Therapeutic hypothermia was induced in all patients with persistent coma after restoration of spontaneous circulation (ROSC). We maintained the target temperature (32– 34 °C) for 12 hours. Then, passive rewarming followed. Intravascular cooling device was not used. A good neurological outcome was considered to be cerebral performance category (CPC) 1 or 2 at hospital discharge.

Results:
Total number of patients was 88 (OHCA n = 63; IHCA n = 25), average age 58 (± 16) years, average APACHE II was 29 (± 6). Men were in 65%. Target temperature was achieved and maintained in 76% of patients. ICU mortality was 32%, hospital mortality 53%. Initial ECG rhytm was VF in 59%, asystoly in 32% and pulsless electrical activity in 9%. Coronary angiography was performed in 57% and PCI in 42% patients. We did not observe severe arrhythmias, minor gastrointestinal bleeding occured in 2%. The infectious complications were recorded: early pneumonia in 7%, tracheobronchitis in 10% and bacteraemia in 1% patients. In the group of 23 patients with VF/ STEMI/ PCI target temperature was achieved and maintained in 91%, ICU and hospital survival rates were 87% and 78%. CPC 1 and 2 was observed in 83% among survivors (n = 15).

Conclusions:
We achieved similar results in patients after non-traumatic cardiac arrest who underwent a protocol with 12 hours of therapeutic hypothermia as in studies reporting 24 hours of hypothermia, particularly in patients with VF/ STEMI/ PCI. Twelve hours of therapeutic hypothermia was associated with a low incidence of infectious complications.

Key words:
therapeutic hypothermia – cardiac arrest – protocol

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