Tertiary Cardiac Intensive Care Unit Research Articles

Echocardiographic image quality deteriorates with the severity of cardiogenic shock

BackgroundTransthoracic echocardiography (TTE) is the primary tool for assessing left ventricular (LV) function in cardiogenic shock (CS). However, inadequate image quality often hinders it. In this retrospective study, we investigated factors associated with LV image quality in patients admitted to the intensive care unit (ICU) with ischemic CS.ResultsTwo critical care physicians accredited in echocardiography independently reviewed the TTEs of 100 patients admitted to our tertiary cardiac ICU with ST-elevation myocardial infarction complicated by CS between October 2016 and September 2019. Endocardial border definition (EBD) was graded for each myocardial segment of the apical 4-chamber and 2-chamber views using a conventional scoring system (1 = good, 2 = suboptimal, 3 = poor, and 4 = not possible). The biplane EBD index (EBDi) was calculated by averaging all segments from both views. An average EBDi of both observers was correlated with clinical and echocardiographic parameters. The median age was 62 years [54, 73], and 78% were males. LV ejection fraction and cardiac index (CI) medians were 29% [20, 35] and 1.93 l/min/m2 [1.40, 2.51], respectively. The median biplane EBDi was nearly suboptimal (1.833 [1.542, 2.083]). There was no correlation between EBDi and age, sex, or body mass index. However, biplane EBDi demonstrated statistically significant correlations with PaO2 (r2 = 0.066, p = 0.01), mean arterial pressure (MAP, r2 = 0.055, p = 0.03), CI (r2 = 0.105, p < 0.01), tricuspid annulus systolic velocity (RV S’, r2 = 0.092, p = 0.01), and tricuspid regurge maximum velocity (TR Vmax, r2 = 0.067, p = 0.01). In a multivariate model, only CI correlated independently with EBDi (r2 = 0.105, p < 0.01). The biplane EBDi predicted CI (area under the curve (AUC) 0.70, p = 0.001) with good sensitivity (71%) and reasonable specificity (61%).ConclusionsThe study suggests that in patients admitted to the ICU with ischemic CS, LV image quality by TTE deteriorates with the severity of shock, as indicated by CI.

Association Between Right Ventricular Systolic Parameters Measured by Echocardiography and Stroke Volume Derived From Pulmonary Artery Catheter in Ischemic Cardiogenic Shock

Objective: To determine the right ventricular (RV) systolic function echocardiographic parameter best associated with native stroke volume (SV) by thermodilution via pulmonary artery catheter (PAC) in patients admitted to intensive care with ST-elevation myocardial infarction (STEMI) complicated by cardiogenic shock (CS).Design, Setting, and Participants: Observational cohort study of 43 prospectively identified patients admitted to a tertiary cardiac intensive care unit in London, UK.Interventions: Simultaneous collection of comprehensive transthoracic echocardiographic, clinical, and PAC-derived hemodynamic data. Seven RV systolic function parameters were correlated with the PAC-derived SV.Measurements and Main Results: The median age was 61 [52, 67], and 36 patients (84%) were male. The median PAC-derived SV and LVEF were 57 ml [39, 70] and 31% [22, 35], respectively. The RV outflow tract velocity time integral (RVOT VTI) and tricuspid plane systolic excursion (TAPSE) correlated significantly with the PAC-derived SV (r = 0.42, p = 0.007, r = 0.37, p = 0.02, respectively). The RVOT VTI was independently associated with and predicted low PAC-derived SV (OR = 1.3, p = 0.03) with a good area under the curve (AUC = 0.71, p = 0.02). The RVOT VTI < 12.7 cm predicted low PAC-derived SV with a sensitivity of 66% and specificity of 72%.Conclusion: RVOT VTI is the echocardiographic RV systolic function parameter that best correlates with PAC-derived native SV in patients with STEMI complicated by CS. This parameter can help guide the hemodynamic management of this cohort.

Temporal trends in acute coronary syndrome by subtype

Abstract Funding Acknowledgements None. Introduction Various studies reported different results in trends regarding acute coronary syndrome (ACS) subtypes over the last years. We performed a retrospective analysis to determine trends in ACS incidence, demographic characteristics of patients, invasive treatment as well as outcomes and mortality of patients with ST elevation myocardial infarction (STEMI); non-STEMI (NSTEMI) and unstable angina (UA) in our tertiary Cardiac Intensive Care Unit (CICU). Methods We collected data from medical records and our electronic hospital information system on all admissions that occured in March 2003, 2013 and 2023 and compared the data. Results Over the years, there was a significant increase in total number of patients in our CICU (74, 87 and 143 per month, respectively). Patients with ACS accounted for more than half of all patients in the investigated period, but without reaching statistical significance for increase (51.4%, 64.4% and 63.6%; p= 0.156). On the other hand, when considering patients with STEMI, there was a significant upgrowth of the number of such patients (6.8% vs 31% vs 28.7%; p&amp;lt;0.001) with a trend of a decrease in the number of NSTEMI (28.4%, 18.4% and 23.8%; p= 0.324) and patients with UA (16.2%, 14.9% and 11.2%; p= 0.528). Percutaneous interventional treatment significantly rose over time (35.6 vs 61.2 vs 67.8%, p&amp;lt;0.01), while application of ICU restricted therapies like vasopressors (1.7% vs 0 vs 6.3%; p= 0.072) and inotropes (6.8% vs 4.7% vs 8.5%; p= 0.356) showed increasing trend, but without reaching statistical significance. However, CICU length of stay (LOS) notably decreased (59h vs 43h vs 22h; p= &amp;lt;0,001) as well as mortality (9.5% vs 5.7% vs 2.8%; p= &amp;lt;0.001). Conclusion We observed a significant increase in the number of STEMI patients with a declining trend in NSTEMI and UA patients, as well as increase in coronary procedures and vasopressors and inotropes administration, all indicating growing acuity and complexity of our patients. On the other hand, LOS and mortality significantly decreased highlighting better outcomes and treatment success.

Use of Levosimendan in patients with INTERMACS 3 profile: weaning from inotropic support and short- to medium-term evolution

Abstract Funding Acknowledgements None. Introduction Patients with advanced heart failure (HF) in cardiogenic shock (CS) present a markedly high mortality rate. For CS patients dependent on inotropes, management is difficult with few therapeutic options available, especially in the absence of a suitability for heart transplantation (HTX) or left ventricular assist device implantation (LVAD), thus associating an even worse prognosis. Purpose With our study we aim to analyse the rate of weaning from inotropic support when Levosimendan, a calcium sensitizer with positive inotropic effects, is used in INTERMACS 3 CS patients and their short to medium-term evolution. We then evaluate if the absence of right ventricular dysfunction, of renal dysfunction, non-ischemic aetiology and QRS width could be predicting factors of a successful weaning from inotropes. Materials and methods We conducted a monocentric retrospective analysis of patients from a tertiary cardiac intensive care unit that have received a 24 hours Levosimendan infusion in the context of INTERMACS 3 cardiogenic shock between August 2015 – April 2023. Results Of the 137 subjects included in the analysis, 62 patients received Levosimendan for INTERMACS 3 CS. The median age was 59±15.3 and 91.9% (n=57) were male. Baseline LVEF was 19±6%, cardiac index 1.67±0.4L/min/m2, median NTproBNP 13 378 ± 11 126ng/L. 51.6% (n=32) had ischemic heart disease and 40.3% (n=25) had dilated cardiomyopathy. After Heart Team discussion, only 37% (n=23) were considered eligible for HTX or LVAD. Successful inotrope weaning was experienced in 68% (n=42). Amongst patients with weaning failure, most outcomes resulted in either death (45%), ambulatory continuous Dobutamine infusion (30%), or benefited from a HTX if eligible (15%). The weaning failure rates were similar amongst patients eligible and non-eligible to HTX or LVAD with different outcomes after weaning failure as shown in Figure 1. The overall survival rates at 1 month and 6 months were of 83.8% and 53.2% respectively, with a significant difference between survival rates according to inotrope weaning success or failure as shown in Figure 2. We found no clinical, biological, or echocardiographic parameter to be significantly associated with an increased probability of weaning. Conclusion Levosimendan use in INTERMACS 3 CS patients provides a good rate of success in weaning from inotropic support and could be a useful tool in allowing treatment optimization and stabilization in non HTX or LVAD eligible patients, as well as being a "bridge to transplantation" alternative. No predicting factors for successful weaning have been identified.

Early quantitative pupillary response parameters have high predictive value for 30-day mortality in patients resuscitated from out-of-hospital cardiac arrest

Abstract Background Despite adequate post-resuscitation treatment following out-of-hospital cardiac arrest (OHCA), early risk of death remains high due to irreversible anoxic brain injury. Objective Neuroprognostication is pivotal, and automated quantitative pupillometry has become an essential part of early multimodal approach. Several quantitative pupillary response parameters are now available, but little evidence exist on their value and timing in neuroprognostication. Purpose To evaluate prognostic value of standard parameters of quantitative pupillometry in OHCA patients. Methods In this observational study we included 138 comatose patients resuscitated from OHCA admitted to a tertiary cardiac intensive care unit. With quantitative pupillometry, change in pupil size (%CH, %), Neurological Pupil index (NPi, scalar value 0–5), constriction velocity (CV, mm/s), maximum CV (MCV, mm/s), dilation velocity (DV, mm/s) and latency of constriction (Lat, s) were measured at admission, at the 24 hours (24h), and 48-hours (48h) time points. Receiver operating characteristics (ROC) curves with calculation of area under the curve (AUC) were applied for assessment of association with 30-day mortality. Results The population were predominantly males, had a mean age of 61±12 years, and 120 (87%) had shockable primary rhythm, 122 (88%) had witnessed cardiac arrest and 51 (37%) died in the first 30 days. Median %CH, CV, MCV, DV and NPi values were significantly lower for diseased patients compared to survivors. ROC analyses (Figure 1) present all parameters, except NPi, at admission with numerically highest values of AUC at 0.82, 0.76, 0.73, and 0.81 for %CH, CV, MCV, and DV respectively, and for NPi at 48h with AUC at 0.81. The admission time point still presented the highest AUC values, &amp;gt;0.84, for CV, MCV, and DV in an adjusted model. Of all the parameters, %CH and NPi maintained the highest prognostic values through all time points, and %CH performed best at admission with AUC at 0.87 and NPi at 24h with AUC at 0.91. At admission the threshold value with 100% specificity for predicting 30-day mortality were 3.75, 0.09, 0.33, and 0.05, with negative predictive value (NPV [95% confidence interval]) at 71% [67–74], 66% [64–69], 67% [65–70], and 69% [66–72] for %CH, CV, MCV, and DV respectively. NPi had best performance at 24h with a cutoff value of 2.90 and NPV at 64% [63–64]. Conclusion %CH and NPi were the strongest prognostic tools for 30-day mortality. Values below 3.75% for %CH at admission and 2.90 for NPi at 24h after archived 100% specificity for 30-day mortality, with NPV at 71% [67–74] and 64% [63–64] respectively. Although performance was persistently high, %CH, CV, MCV, and DV presented numerically highest AUC at admission. Additional parameters of CV, MCV, and DV were also significantly associated with outcome and future research should focus on validation and possible combining these measures into useful indices. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): Novo Nordisk Foundation

250 Advanced management of out of hospital cardiac arrest: a single-centre experience in a tertiary cardiac intensive care unit

Abstract Aims Out-of-hospital cardiac arrest (OHCA) affects around 1/1000 person-years. Following return of spontaneous circulation (ROSC), the patient can manifest neurological impairment. A targeted temperature management (TTM) protocol is recommended to prevent hypoxic–ischaemic brain damage in patients with coma after cardiac arrest. Neuro-prognostication remains substantial for the prediction of clinical outcomes. To study clinical characteristics, overall survival, and neurological outcome of patients with Glasgow Coma Scale (GCS) &amp;lt;8 after ROSC following an OHCA of presumed cardiac cause at our Institution. Secondly, to investigate determinants of a negative neurological outcome. Methods Observational retrospective study evaluating all patients with OHCA of presumed cardiac cause and with GCS &amp;lt; 8 after ROSC treated in an intensive cardiac care unit of a tertiary centre. The study period was from January 2017 to December 2020. Results One-hundred and five patients out of 107 patients initially selected were included in the study (77% male, mean age 67 years). At 30 days, mortality was 41% and 53% of patients had a poor neurological outcome (Cerebral Performance Category, CPC, 3–5). Sixty-nine patients (66%) underwent TTM. In regard of the circumstances of OHCA, index event in a private place [OR = 3.12 (1.43–7.11), P = 0.005], ineffective rhythm changes during resuscitation manoeuvres [OR = 2.40 (1.05–5.47), P = 0.037] and a greater amount of adrenaline administered during resuscitation [OR = 1.62 (1.27–2.06), P &amp;lt; 0.001] were related to a worse neurological outcome. A history of diabetes mellitus [OR = 3.35 (1.26–8.91), P = 0.015], blood lactates at presentation [OR = 1.33 (1.15—1.53), P &amp;lt; 0.001], neuron-specific enolase (NSE) at presentation [OR = 1.055 (1.022–1.089), P &amp;lt; 0.001] and as peak [OR = 1.034 (1.013–1.054), P &amp;lt; 0.001] were associated with a worse neurological outcome. Among the neurological examinations, the presence of status epilepticus on the EEG [OR = 13.97 (1.73–113.02), P = 0.013] was a predictor of a poor neurological outcome. Treatment with targeted temperature management did not show a significant impact in terms of outcome at univariate analysis [OR = 1.226 (0.547–2.748), P = 0.62]. Two models were developed with multivariate logistic regression for the prediction of neurological outcome. The first one, on a statistical basis, considers pupil reactivity after ROSC, NSE as peak and left ventricular ejection fraction (AUC = 92%). The second model, on a clinical basis, considers age, first blood lactate value and NSE as peak (AUC = 89 %). Finally, the performance of the multiparametric MIRACLE score was tested in our population (AUC 0.81 for neurological outcome at 30 days). Conclusions In our population, at 30 days after cardiac arrest, survival rate and the rate of good neurological outcome were comparable to those of the major international registries and studies. Even though patients treated with TTM did not demonstrate significant differences in terms of neurological outcome, this might be related to study-sample size and patient selection. Results in the literature are still controversial on this topic. The MIRACLE score showed a good performance, making it suitable for clinical use in our population. Similarly, the proposed multivariate models are potentially useful for the elaboration of simple and effective prognostic scores in neurological risk stratification.

Laboratory Markers of Acidosis and Mortality in Cardiogenic Shock: Developing a Definition of Hemometabolic Shock.

Acidosis and higher lactate predict worse outcomes in cardiogenic shock (CS) patients. We sought to determine whether overall acidosis severity on admission predicted in-hospital mortality in CS patients. This retrospective descriptive analysis included CS patients admitted to a single academic tertiary cardiac intensive care unit from 2007 to 2015. Admission arterial pH, base excess, and anion gap values were used to generate a Composite Acidosis Score (range 0-5, with a score ≥2 defining Severe Acidosis). Adjusted in-hospital mortality was analyzed using multivariable logistic regression. We included 1,065 patients with median age of 68.9 (59.0, 77.2) years (36.4% females). Concomitant diagnoses included cardiac arrest in 38.1% and acute coronary syndrome in 59.1%. Severe Acidosis was present in 35.2%, and these patients had worse shock and more organ failure. In-hospital mortality occurred in 34.1% and was higher among patients with Severe Acidosis (54.9% vs. 22.4%, adjusted odds ratio [OR] 2.01, 95% CI 1.43-2.83, P < 0.001). Increasing Composite Acidosis Score was associated with higher in-hospital mortality (adjusted OR 1.25 per point, 95% CI 1.11-1.40, P < 0.001). Severe Acidosis was associated with higher hospital mortality at every level of shock severity and organ failure (all P < 0.05). Admission lactate level had equivalent discrimination for in-hospital mortality as the Composite Acidosis Score (0.69 vs. 0.66; P = 0.32 by De Long test). Given its incremental association with higher in-hospital mortality among CS patients beyond shock severity and organ failure, we propose Severe Acidosis as a marker of hemometabolic shock. Lactate levels performed as well as a composite measure of acidosis for predicting mortality.

Abstract 14494: Once You 1c It, You Can’t Unsee It: A Case of Flecainide Toxicity

Introduction: Flecainide is a class 1c antiarrhythmic commonly used for the treatment of atrial and ventricular arrhythmias in the absence of underlying structural heart disease. The significant proarrhythmic effects of the drug warrant familiarity with the drug and its toxicity. Flecainide overdose, whether intentional or iatrogenic, is a life threatening emergency with mortality rates as high as 22.5%. We present a case of intentional flecainide overdose and its management. Case: A 78-year-old man with a history of heart failure, paroxysmal atrial fibrillation on flecainide, presented to a local ED after a suicide attempt. He was initially hemodynamically stable and a 12-lead EKG revealed a wide-QRS bradyarrhythmia (See figure 1). Electrolyte panel showed normal potassium and pH. During transport to our tertiary cardiac intensive care unit, the patient declined and was critically ill on arrival. The diagnosis of flecainide toxicity was suspected and therapy was initiated on arrival. Despite therapy with sodium bicarbonate and fat emulsion, the patient continued to decline. Renal replacement therapy was started and the patient was evaluated for mechanical circulatory support. Ultimately, the patient’s family elected for palliative extubation. The patient’s flecainide level returned more than four times above the therapeutic range. Discussion: This case highlights the importance of a high index of suspicion when faced with a wide-QRS arrythmia in a patient with suspected antiarrhythmic overdose. The persistence of these rhythms after correction of acid-base abnormalities and electrolyte derangements should prompt aggressive, empiric treatment of potential overdose. The presence of electromechanical dyssynchrony in this context is an ominous sign and should prompt simultaneous evaluation for biventricular mechanical circulatory support concomitant with medical therapy for suspected overdose. Figure 1

Abstract 15559: In-hospital versus Out-of-hospital Cardiac Arrest in Patients Presenting to Cardiac Intensive Care Units: From the Critical Care Cardiology Trials Network (CCCTN) Registry

Background: Cardiac arrest (CA) is a common reason for cardiac intensive care unit (CICU) admission and is associated with considerable morbidity, mortality, and resource use. Aim: To describe characteristics and outcomes of pts presenting to contemporary CICUs with in-hospital (IH) or out-of-hospital (OH) CA. Methods: The Critical Care Cardiology Trials Network (CCCTN) is a multicenter network of tertiary CICUs in North America (n=25). Participating centers contributed data from consecutive admissions during 2-month annual snapshots between 9/2017 and 8/2019 (n=8240). We analyzed characteristics and outcomes of pts with CA by IHCA vs OHCA. Results: Of 975 admissions with CA (48.9% OHCA), most were male (64.7%), Caucasian (63.4%) and smokers (60.6%). Acute coronary syndrome (ACS) was present in 30.6% and cardiomyopathy in 21.8%. Shockable rhythm was present in 54.1%, more commonly among those with reduced ejection fraction, ischemic cardiomyopathy, or ACS (p&lt;0.01 for all). Compared with IHCA, patients with OHCA were younger (median age 62 vs 66 years) and had fewer comorbidities including heart failure, atrial fibrillation, valvular disease, pulmonary HTN, and CKD (p&lt;0.01 for all). Pts with OHCA more commonly had shockable rhythms (58.3% vs 50.0%) and were more likely to be comatose at initial assessment (75.7% vs 40.4%); p&lt;0.01 for both. Resource use varied significantly between OHCA and IHCA [ Fig ] and CICU length of stay was longer for pts with OHCA (median 3.4 vs 3.1 days; p=0.049). In-hospital mortality was 41.2% and was higher in OHCA (44.7%) compared with IHCA (38.0%), p=0.03 [ Fig ]. Eventual discharge home or to rehab was more common among pts with IHCA (51.6% vs 49.1% for OHCA; p&lt;0.01). Conclusion: Despite advances in pre- and in-hospital care, pts presenting to contemporary CICUs with CA have high in-hospital mortality, with IHCA mortality only modestly lower than in OHCA. A better understanding of patterns may guide new approaches to improve patient outcomes.

Demographics, Care Patterns, and Outcomes of Patients Admitted to Cardiac Intensive Care Units

Single-center and claims-based studies have described substantial changes in the landscape of care in the cardiac intensive care unit (CICU). Professional societies have recommended research to guide evidence-based CICU redesigns. To characterize patients admitted to contemporary, advanced CICUs. This study established the Critical Care Cardiology Trials Network (CCCTN), an investigator-initiated multicenter network of 16 advanced, tertiary CICUs in the United States and Canada. For 2 months in each CICU, data for consecutive admissions were submitted to the central data coordinating center (TIMI Study Group). The data were collected and analyzed between September 2017 and 2018. Demographics, diagnoses, management, and outcomes. Of 3049 participants, 1132 (37.1%) were women, 797 (31.4%) were individuals of color, and the median age was 65 years (25th and 75th percentiles, 55-75 years). Between September 2017 and September 2018, 3310 admissions were included, among which 2557 (77.3%) were for primary cardiac problems, 337 (10.2%) for postprocedural care, 253 (7.7%) for mixed general and cardiac problems, and 163 (4.9%) for overflow from general medical ICUs. When restricted to the initial 2 months of medical CICU admissions for each site, the primary analysis population included 3049 admissions with a high burden of noncardiovascular comorbidities. The top 2 CICU admission diagnoses were acute coronary syndrome (969 [31.8%]) and heart failure (567 [18.6%]); however, the proportion of acute coronary syndrome was highly variable across centers (15%-57%). The primary indications for CICU care included respiratory insufficiency (814 [26.7%]), shock (643 [21.1%]), unstable arrhythmia (521 [17.1%]), and cardiac arrest (265 [8.7%]). Advanced CICU therapies or monitoring were required for 1776 patients (58.2%), including intravenous vasoactive medications (1105 [36.2%]), invasive hemodynamic monitoring (938 [30.8%]), and mechanical ventilation (652 [21.4%]). The overall CICU mortality rate was 8.3% (95% CI, 7.3%-9.3%). The CICU indications that were associated with the highest mortality rates were cardiac arrest (101 [38.1%]), cardiogenic shock (140 [30.6%]), and the need for renal replacement therapy (51 [34.5%]). Notably, patients admitted solely for postprocedural observation or frequent monitoring had a mortality rate of 0.2% to 0.4%. In a contemporary network of tertiary care CICUs, respiratory failure and shock predominated indications for admission and carried a poor prognosis. While patterns of practice varied considerably between centers, a substantial, low-risk population was identified. Multicenter collaborative networks, such as the CCCTN, could be used to help redesign cardiac critical care and to test new therapeutic strategies.

Reducing Blood Testing in Pediatric Patients after Heart Surgery: Proving Sustainability.

Frequent blood testing increases risk of iatrogenic anemia, infection, and blood transfusion. This study describes 3 years of sustained blood testing reduction from a quality improvement (QI) initiative which began in 2011. The cohort consisted of postop children whose surgery had a Risk Adjustment for Congenital Heart Surgery (RACHS) classification consecutively admitted to a tertiary Cardiac Intensive Care Unit. Data were collected for a 2010 preintervention, 2011 intervention, and 2012-13 postintervention periods, tabulating common laboratory studies per patient (labs/pt) and adjusted for length of stay (labs/pt/d). The QI initiative eliminated standing laboratory orders and changed to testing based on individualized patient condition. Adverse outcomes data were collected including reintubation, central line-associated bloodstream infections and hospital mortality. Safety was measured by the number of abnormal laboratory studies, electrolyte replacements, code blue events, and arrhythmias. A total of 1169 patients were enrolled (303 preintervention, 315 intervention, and 551 postintervention periods). The number of labs/pt after the QI intervention was sustained (38 vs. 23 vs. 23) and labs/pt/d (15 vs. 11 vs. 10). The postintervention group had greater surgical complexity (P = 0.002), were significantly younger (P = 0.002) and smaller (P = 0.008). Children with RACHS 3-4 classification in the postintervention phase had significant increased risk of reintubation and arrhythmias. After the implementation of a QI initiative, blood testing was reduced and sustained in young, complex children after heart surgery. This may or may not have contributed to greater reintubation and arrhythmias among patients with RACHS 3-4 category procedures.

Abstract 18391: The Effect of Targeted Temperature Management on the Neurologic Outcome of In-hospital Cardiac Arrest Survivors

Introduction: Cooling patients that have been resuscitated from out-of-hospital cardiac arrest (OHCA) using targeted temperature management (TTM) is standard of care. However the role of TTM in patients after in-hospital cardiac arrest (IHCA) is presently unclear. Hypothesis: We evaluated the effect of TTM on neurologic outcome of patients after successful resuscitation from IHCA Methods: A retrospective analysis was performed on prospectively collected data from 112 consecutive, adult IHCA patients admitted to a tertiary cardiac intensive care unit between January 1, 2004, and June 1, 2013. Patients were categorized into the hypothermia group (underwent TTM) and the control group (did not undergo TTM). Univariable as well as multivariable analyses by binomial logistic regression were performed on the collected data. The primary outcome was defined as neurologic outcome at hospital discharge using the cerebral performance categories (CPC) (Good= CPC 1-2 and Bad= CPC 3-5 respectively). Results: Of the 112 patients who formed the study cohort, 84 patients formed the hypothermia group and 28 patients formed the control group. The two groups were similar with respect to age, gender, ethnicity, past medical history, smoking, rate of witnessed cardiac arrest, and time to return of spontaneous circulation(P&gt;0.05). On univariable analysis 34(41%) patients in the hypothermia group had good neurologic outcome as compared to 5 (18%) patients in the control group (p=0.03). On multivariable analysis the use of TTM was the only independent predictor of good neurologic outcome (OR=3.79, 95 % CI: 1.18-12.79, P=0.024).(Figure) Conclusions: The use of TTM in patients resuscitated from IHCA is associated with significantly better neurologic outcome as compared to similar patients who did not undergo TTM. Larger studies are required to corroborate this finding.

Clinical predictors of outcome in survivors of out-of-hospital cardiac arrest treated with hypothermia

BackgroundOut-of-hospital cardiac arrest (OHCA) is a leading cause of death and severe neurological disability. The objective of this study was to identify clinical predictors of early neurological outcome in survivors of OHCA managed according to recent recommendations for OHCA care. MethodsData from survivors of OHCA, admitted to a tertiary cardiac intensive care unit and treated with hypothermia in a 22 months period (n=46, age 60±13 years, 74% males) were retrospectively evaluated. At 1-month follow-up, patients were classified according to the best achieved Glasgow–Pittsburgh cerebral performance categories (CPC 1–5) and factors affecting the outcome were analysed. ResultsAt 1-month follow-up, 23 patients (50%) had favourable outcome (CPC 1–2), while 23 patients (50%) had poor outcome (CPC 3–5), including 19 with in-hospital death (41% of total). Patients with good outcome were younger (55±13 years vs. 66±10 years; P=0.003), had more often myocardial infarction as the cause of arrest (63% vs. 30%; P=0.018) and ventricular fibrillation/tachycardia as an initial rhythm (78% vs. 39%; P=0.007). Both groups differed by lactate level on admission (4.0±4.6 vs. 7.3±4.1mmol/l, P=0.02), after 12h (2.5±1.1 vs. 4.3±3.2mmol/l, P=0.04) and after 24h (1.9±1.2 vs. 3.2±1.9mmol/l, P=0.04). Logistic regression revealed the following independent outcome predictors: age, acute myocardial infarction and admission lactate level. ConclusionFavourable outcome was observed in a half of OHCA survivors. Young age, acute myocardial infarction as underlying aetiology of cardiac arrest, and low lactate level on admission were the best predictors of favourable outcome.