Abstract 21137: Nationwide Trends and Outcomes of Mechanical Circulatory Support With and Without Therapeutic Hypothermia for In-Hospital Cardiac Arrest

Abstract

Introduction: In-hospital cardiac arrest (IHCA) is associated with elevated morbidity and mortality. Despite advances in cardiopulmonary resuscitation (CPR), survival remains dismal. The use of mechanical circulatory support (MCS) and therapeutic hypothermia (TH) have shown to improve outcomes when compared to conventional CPR in selected patients with IHCA. Limited studies describe the use of TH in patients receiving MCS during IHCA and there is currently no evidence demonstrating benefit of MCS with TH over MCS at normothermia. Methods: Using the National Inpatient Database we identified patients with IHCA from 2004 to 2014. Using ICD-9 procedure codes, we identified the use of TH and MCS. Univariate and multivariate linear and logistic regression models were generated to identify specific outcomes and in-hospital mortality. Results: Of 1,073,093 patients that underwent in-hospital CPR during 2004 to 2014, 2.7% had MCS without TH, 0.84 % underwent TH without MCS and 0.1% underwent TH with MCS. Baseline characteristics for each group are shown in Table 1. In patients who underwent MCS alone, 90.6% had balloon pump, 6.1% had extracorporeal membrane oxygenator and 3.3% had peripheral ventricular assisted device. In this group, 48% underwent percutaneous coronary intervention (PCI) and 42.5% of patients survived to discharge with half of them being discharged home (52.2%) and 31.2% to a nursing home or facility. Of those who received TH without MCS, fewer patients underwent PCI (6.1%) and 28.8% survived to discharge (48.6% being discharge to nursing home or facility). Of those who underwent MCS and TH, 55.6% underwent PCI and 35.8% survived to discharge. Conclusions: Use of MCS was associated with better survival outcomes and higher rate of PCI, regardless of the use of TH. No significant difference in mortality was noted in patients with HT without MCS (28.8% compared to the overall sample 27%).