Abstract 18794: Systemic Heparin Use and Outcomes in Cardiac Arrest Patients Treated With Therapeutic Hypothermia Without Coronary Intervention

Abstract

Introduction: The effects of hypothermia on hemostatic function are complex and poorly understood. While cardiac arrest and CPR can elicit a pro-inflammatory, pro-coagulant state, hypothermia may alter platelet count, activation and aggregation. Hypothesis: We hypothesized that treatment with systemic heparin during therapeutic hypothermia (TH) is associated with improved neurologic outcomes. Methods: We conducted a retrospective study of 157 cardiac arrest survivors treated with TH at our institution from 2007-2014. A priori, we excluded TH patients (pts) presenting with an acute coronary syndrome requiring percutaneous coronary intervention, pulmonary embolus, venous thrombosis or need for mechanical circulatory support. We used a multivariable logistic regression model to examine the relationship between systemic heparin and neurologic outcome (Cerebral Performance Category score 1-2=good; 3-5=poor) as well as inpatient survival. We also performed a chi-square analysis for the secondary endpoint of major bleeding. Results: Mean age was 57.0 (+/- 16.2) years; 86 (54%) pts were male; and 75 (47.8%) pts had an initial rhythm of ventricular tachycardia or ventricular fibrillation. At discharge, 48 (30.6%) pts had a good neurologic outcome and 23 (14.7%) pts suffered from a major bleed. Systemic heparin was administered to 48 (30.6%) pts, and was neither associated with favorable neurologic outcome (OR 0.99, CI 0.39-2.56, p=0.991) nor inpatient survival (OR 1.28, CI 0.54-3.05, p=0.574). The risk of bleeding with heparin was 2.08 (CI 0.99-4.38, p=0.052). Conclusions: In our cohort, indiscriminate use of systemic heparin during TH post-cardiac arrest was not associated with improved neurologic outcomes. Conversely, a trend towards increased risk of major bleeding was noted.