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Abstract

Introduction: Outcomes after cardiac arrest or cardiogenic shock carry a poor prognosis. Induced therapeutic hypothermia has become the standard of care in many hospitals since its 2003 endorsement by AHA/ILCOR for the care of patients post cardiac arrest or suffering from cardiogenic shock. Methods: Data were collected on 833 consecutive adult patients with diagnoses of cardiac arrest or cardiogenic shock admitted to ICUs in four hospitals in the US 2008-2012. Data on hospital and ICU mortality, ICU LOS, and the variables required by APACHE for predicting these outcomes were obtained. We also collected information on type of rhythm at arrest, downtime, and time to return of spontaneous circulation. Results: 248 patients (32%) received ITH during their ICU stay. These patients had higher hospital mortality than those not receiving that therapy (53.7% vs. 68.1%). After risk adjustment with APACHE IV, SMRs of 1.02 and 1.19 respectively (p=.04) indicated no benefit from the intervention. When analyzed by length of downtime and cardiac rhythm at admission, patients with vfib/vtach appeared to have better outcomes than those with PEA or asystole, however the high number of patients with unknown values on admission may skew these values. There was no significant difference in ICU length of stay or mortality within the ICU. Conclusions: Patients selected to receive ITH are more severely ill than those not treated with ITH. In this sample, ITH had no effect and potentially a negative effect on risk-adjusted hospital mortality for PEA and asystole patients. Ongoing evaluation of the efficacy of this intervention is needed, and outcomes beyond mortality and length of stay (such as neurological status or functional status) need to be evaluated.