Abstract
Background: Recent guidelines on cardiopulmonary resuscitation have stressed that comatose adult patients with return of spontaneous circulation (ROSC) after out-of-hospital cardiac arrest (OHCA) have targeted temperature management, including therapeutic hypothermia (TH). However, it is unknown whether the TH for patients with ROSC after cardiac arrest presenting with cardiovascular shock is useful. The aim of the present study was to clarify the effects of the TH for patients with ROSC after OHCA presenting with cardiovascular shock at hospital arrival, using the data of the Japanese Circulation Society (JCS) Cardiovascular Shock registry, a prospective, observational, multicenter cohort study. Methods: From the data of this registry between 2012 and 2014, we included comatose adult patients presenting with cardiovascular shock. The primary endpoint was survival rates at 30 days after hospital arrival, and the secondary endpoint was favorable neurological outcome at the discharge. Results: Of the 1004 patients registered in the JCS-Shock Registry, the data of 339 patients were included in this analysis. Of the 339 patients, 149 had received TH, 190 had not received (p=0.026). Figure showed the endpoints in the entire study population, in patients with ROSC after OHCA and in the patients with ROSC after OHCA, who had not received veno-arterial extracorporeal membrane oxygenation (VA ECMO). In the multivariate analysis, the adjusted odds ratio for 30-day survival in patients receiving TH as compared to patients not receiving TH was 2.806 (95%CI 1.195-5.268, p=0.001) in the entire study population, 3.194 (95% CI 1.597-6.386, p=0.001) in patients with ROSC after OHCA, 2.469 (95%CI 1.238-4.924, p=0.01) in the patients with ROSC after OHCA not receiving VA ECMO, respectively. Conclusion: On the basis of these results, the TH for the patients with ROSC after OHCA presenting with cardiovascular shock was useful in terms of 30-day survival, but not neurological benefits.
Published Version
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