Abstract 317: The Los Angeles Cardiac Arrest Network: Hypothermia Experience in Nonshockable Rhythm

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Therapeutic hypothermia after resuscitation from a non-shockable cardiac arrest rhythm: Outcomes in a regionalized cardiac arrest system Introduction: Therapeutic hypothermia (TH) improves neurologic outcome (CPC 1-2) in patients resuscitated from VF. Its effect on neurologic outcome following resuscitation from non-shockable arrest rhythms remains uncertain. Of equal importance is the possibility that TH will improve survival in this group but not neurologic outcome (CPC 3-4). The purpose of this study was to evaluate neurologic outcome in patient resuscitated from a non-shockable out-of-hospital cardiac arrest rhythm. Methods: This is a retrospective cohort study of data reported to a single registry from EMS systems serving a population of approximately 10 million and collected between April 1 and Dec 31, 2011. All patients achieving ROSC in the field are transported to designated hospitals with TH protocols and PCI capabilities. The registry includes current Utstein data cells. Patients with an initial non-shockable rhythm were identified. Patients were excluded if they were awake and responsive in the ED. The survival rate and neurologic outcome of those receiving TH were compared to those that did not receive TH. The decision to initiate or withhold TH was determined by the treating physician. Results: Outcomes are shown in the table. The OR for a CPC 1 or 2 with TH was 2.4 (95%CI 1.1-5.5)(p=0.01) compared to patients not receiving TH. The proportion of patients with CPC 3 or 4 was not different between groups, unpaired t-test (p=0.6). Conclusion: TH improves neurologic outcome in patients resuscitated from initial non-shockable rhythms in a regionalized system for post-resuscitation care. Additionally, the number of surviving but severely neurologically impaired patients is not increased.