Abstract
Objective. Out of hospital cardiac arrest (OHCA) patients are a critically ill patient population with high mortality. Combining mild therapeutic hypothermia (MTH) with early coronary intervention may improve outcomes in this population. The aim of this study was to evaluate predictors of mortality in OHCA patients undergoing MTH with and without cardiac catheterization. Design. A retrospective cohort of OHCA patients who underwent MTH with catheterization (MTH + C) and without catheterization (MTH + NC) between 2006 and 2011 was analyzed at a single tertiary care centre. Predictors of in-hospital mortality and neurologic outcome were determined. Results. The study population included 176 patients who underwent MTH for OHCA. A total of 66 patients underwent cardiac catheterization (MTH + C) and 110 patients did not undergo cardiac catheterization (MTH + NC). Immediate bystander CPR occurred in approximately half of the total population. In the MTH + C and MTH + NC groups, the in-hospital mortality was 48% and 78%, respectively. The only independent predictor of in-hospital mortality for patients with MTH + C, after multivariate analysis, was baseline renal insufficiency (OR = 8.2, 95% CI 1.8–47.1, and p = 0.009). Conclusion. Despite early cardiac catheterization, renal insufficiency and the absence of immediate CPR are potent predictors of death and poor neurologic outcome in patients with OHCA.
Highlights
Over 350,000 out of hospital cardiac arrests (OHCA) occur each year in the United States, with around 45,000 cardiac arrests occurring each year in Canada [1]
Numerous other case series have illustrated that early coronary angiography and percutaneous coronary intervention (PCI), combined with Mild therapeutic hypothermia (MTH), produce the highest longterm survival rates among patients who remain comatose after resuscitated cardiac arrest [11,12,13,14]
A total of 176 consecutive patients with a documented cardiac arrest who were admitted to a single tertiary care ICU and underwent MTH were the initial study population
Summary
Over 350,000 out of hospital cardiac arrests (OHCA) occur each year in the United States, with around 45,000 cardiac arrests occurring each year in Canada [1]. It remains an important goal to develop therapeutic strategies to improve survival in this patient population. Studies have investigated the combination of early interventional strategies with MTH as a means of further improving long-term survival in resuscitated cardiac arrest patients with evolving evidence of ST elevation myocardial infarction (STEMI). Numerous other case series have illustrated that early coronary angiography and percutaneous coronary intervention (PCI), combined with MTH, produce the highest longterm survival rates among patients who remain comatose after resuscitated cardiac arrest [11,12,13,14]. Immediate angiography and PCI as indicated were recommended in resuscitated OHCA patients whose initial ECG shows ST-segment elevation [15]
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