Abstract 242: Incidence and Relevance of Pulmonary Edema as a Result of Large-Volume, Ice-Cold Saline Infusion for the Induction of Hypothermia During Out-of-Hospital Cardiopulmonary Resuscitation

Abstract

Background: New York City Project Hypothermia is a collaborative effort involving the Fire Department of New York (FDNY), Greater New York Hospital Association, Health and Hospitals Corporation, the Regional Emergency Medical Advisory Committee, and the New York State Department of Health. As part of this effort, the FDNY implemented a pilot protocol that introduced the induction of therapeutic hypothermia during initial resuscitation efforts for nontraumatic adult cardiac arrests. Purpose: We sought to measure the incidence of pulmonary edema among patients receiving large-volume, ice-cold saline during initial resuscitation efforts and to assess the impact of this condition on immediate outcomes. Methods: Out-of-hospital cardiac arrest data was analyzed for the following periods: August 1, 2009 - May 31, 2010 (historical control group) and August 1, 2010 - May 31, 2011 (study group). Pulmonary edema was defined as having occurred if clinical signs and symptoms were reported by the on-scene paramedics during a standardized post-resuscitation interview. Data were analyzed using Fisher's exact test, and a p <0.05 was considered significant. Results: There were 5,582 resuscitations during the control period and 4,727 resuscitations in the study period. Return of spontaneous circulation (ROSC) and sustained ROSC occurred among 29.0% and 21.9% of the control group and 31.7% and 24.1% of the study group, respectively. A total of 361/4,727 patients (7.6%) in the study period were experienced pulmonary edema. The ROSC and sustained ROSC rates for this population were 37.1% and 25.2%, respectively. These outcomes were significantly improved as compared to both the control group and the remainder of the study group (all p <0.01). Conclusion: Clinical signs of pulmonary edema develop in some out-of-hospital cardiac arrest patients receiving large volume, ice-cold saline infusion for the purpose of initiating therapeutic hypothermia. Given the improved immediate outcomes among these patients, the clinical relevance of this clinical condition is of uncertain significance.