Prehospital Immediate Therapeutic Hypotermia in Galicia: Results and Next Steps

Abstract

Introduction: Despite mild therapeutic hypothermia (TH) being recommended as a post-resuscitation care by current international resuscitation guidelines, recent evidences have questioned its role. Our objective was to assess the results of immediate TH at the pre hospital level by the Galicia’s Emergencies Medical Service (GEMS) in order to know the potential impact on patient’s outcome. Methods: Observational retrospective study. Patients older than 18 years with a witnessed out-of-hospital cardiac arrest (OHCA), and with recovering of spontaneous circulation (ROSC) after advanced cardiopulmonary resuscitation (CPR) provided by sanitary personnel of the GEMS, between 2005 and 2013 were eligible. The survival and brain function at hospital discharge and one year after OHCA were assessed comparing the patients treated with immediate after ROSC pre hospital mild TH with patients receiving standard care. Results: One hundred ninety one patients were included, 94 (49.2%) with shockable rhythm (VF); 56 (29.3%) received TH; 36 of them (64.3%) with VF. Survival at hospital discharge and 1-year after OHCA was 55.4% and 51.8% in the TH group, versus 28.9% and 22.9% respectively in control group (p<0.001 both). Also, percentage of patients with CPC score 1-2 was higher in the TH group: 80.6% vs. 56.4 at hospital discharge (p<0.05) and 93.10% vs. 70.9% at one year follow-up (p<0.01). TH was an independent predictive factor of long-term survival, both in VF (OR=3.83; 95% CI: 0.40-36.96) as in no-shockable rhythms (OR=3.50; 95% CI: 0.31-39.15). Conclusions: In Galicia, immediate after ROSC pre hospital TH improved survival and functional status at short and long-term, independently of the first recorded ECG rhythm. Although limited, our data have been obtained from the real-life GEMS working conditions and should be considered in before radical modifications of CPR protocols.