Abstract

IntroductionA large number of patients resuscitated for primary cardiac arrest arrive in the intensive care unit (ICU) with a body temperature < 35.0°C. The aim of this observational cohort study was to determine the association between ICU admission temperature and neurological outcome in this patient group.MethodsDemographics and parameters influencing neurological outcome were retrieved from the charts of all patients resuscitated for primary cardiac arrest and treated with induced mild hypothermia in our ICU from January 2006 until January 2008. Patients were divided into two groups according to their body temperature on ICU admission: a hypothermia group (< 35.0°C) and a non-hypothermia group (≥35.0°C). Neurological outcome after six months was assessed by means of the Glasgow Outcome Score (GOS), with GOS 1 to 3 defined as unfavorable and GOS 4 to 5 as favorable. A logistic regression model was used to analyze the influence of the different parameters on neurological outcome.ResultsThe data of 105 consecutive patients resuscitated for primary cardiac arrest and treated with induced mild hypothermia were analyzed. Median ICU admission temperature was 35.1°C (interquartile range (IQR) 34.3 to 35.7). After six months, 61% of the patients had an unfavorable outcome (59% died and 2% were severely disabled), whereas 39% had a favorable outcome (moderate disability or good recovery). Among patients with spontaneous hypothermia on ICU admission, the percentage with unfavorable outcome was higher (69% versus 50%, P = 0.05). Logistic regression showed that age, acute physiology and chronic health evaluation (APACHE) II and sequential organ failure assessment (SOFA) scores and spontaneous hypothermia on ICU admission all had an increased odds ratio (OR) for an unfavorable outcome after six months. Spontaneous hypothermia had the strongest association with unfavorable outcome (OR 2.6, 95% CI (confidence interval) 1.1 to 5.9), which became even stronger after adjustment for age, presenting heart rhythm, APACHE II and SOFA scores (OR 3.8, CI 1.3 to 11.0).ConclusionsIn this observational cohort study, spontaneous hypothermia on ICU admission was the strongest predictor of an unfavorable neurological outcome in patients resuscitated for primary cardiac arrest.

Highlights

  • A large number of patients resuscitated for primary cardiac arrest arrive in the intensive care unit (ICU) with a body temperature < 35.0°C

  • The aim of the current study was to analyze whether spontaneous hypothermia on ICU admission was a predictor of neurological outcome in patients resuscitated for primary cardiac arrest

  • As the current study was not performed prospectively, the time to return of spontaneous circulation was not systematically recorded in the patient files and was difficult to retrieve in a reliable manner. Another limitation of our study is that we did not analyze other reasons for hypothermia, such as ambient temperature on the site of resuscitation or in the ambulance. This observational cohort study demonstrates that spontaneous hypothermia on ICU admission after resuscitation for primary cardiac arrest was associated with an unfavorable neurological outcome, possibly due to more extensive brain injury

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Summary

Objectives

The aim of the current study was to analyze whether spontaneous hypothermia on ICU admission was a predictor of neurological outcome in patients resuscitated for primary cardiac arrest

Methods
Results
Discussion
Conclusion

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