1039: ON THIN ICE? REEVALUATING THE CLINICAL NEED FOR ENDOVASCULAR COOLING CATHETERS IN POST-ROSC CARE

Abstract

Introduction: Targeted temperature management (TTM) is a widely practiced standard of care in post-cardiac arrest patients. Methods can include standard external cooling devices (SECD) and endovascular cooling catheters (ECC). Recent literature suggests that hypothermia is nonsuperior to normothermic therapy in reducing mortality amongst post-cardiac arrest patients. In a post-hoc analysis, ECCs were superior in achieving and maintaining target temperatures compared with SECDs. We aimed to re-examine the clinical benefit of using ECCs compared to SECDs in TTM of pre-hospital cardiac arrest patients in a real life clinical setting in an attempt to standardize provider practice in our institution. Methods: 116 patients presenting to the ED across 2019 suffering a pre-hospital cardiac arrest were retrospectively identified. Charts were separated into three groups: ECCs, alternative cooling methods, or no cooling and examined for temperature maintained over a 48 hour period after TTM initiation or admission, length of ICU stay, complications rates, and 28-day mortality. Kruskal Wallis test was used to detect a significant difference in mean temperature. Secondary outcomes were compared using independent sample t-tests. Results: 103 charts were analyzed and 13 charts removed for incomplete data. There was a statistically significant difference in maintenance of target temperature > 24 hours between patients in the “ECC group” compared to the “no cooling” and “alternative cooling methods” groups (p=< 0.0001). We found no significant differences in length of hospital stay (p=0.730), and overall mortality (p=0.881) between the three groups (p=0.881). Mean indwelling catheter time was one day. Complications included arterial puncture (n=1) in the ECC group. Conclusions: This retrospective study supports current literature suggesting superior TTM by ECCs. However, ECCs pose no significant benefit in reducing the length of ICU stay or decreasing mortality compared to standard methods, consistent with prior prospective studies. With the lack of significant survival benefits and increased risk of complications, the usage of ECCs may be more harmful than beneficial. The clinical merits of ECCs must be questioned and noninvasive measures should be considered more readily.