Introduction

1. Implementation of a Therapeutic Hypothermia Protocol in a Community Hospital Emergency Department Christine Kulstad, MD, David Barounis, MD, and Elise Lovell, MD Department of Emergency Medicine, Advocate Christ Medical Center, Oak Lawn, Illinois Results Introduction Limitations • Seventy-nine patients were treated with therapeutic hypothermia with a mortality rate of 70.9% (95% CI 60-80%). • Mortality was 72.3% in 47 historical control patients (95% CI 57-86%). • Nine patients, 11.4% (95% CI 6.1-20.3%), in the hypothermia group had good neurological outcome at discharge compared to none in the control group. • In patients presenting with VF/VT, mortality was 56% (95% CI 6.1-20.3%) in the therapeutic hypothermic group, compared with 67% (95% CI 28-100%) in the control group. Good neurological outcome was seen in 20% (95% CI 8.9-39.1%) therapeutic hypothermia patients, compared with 0 (95% CI 0-30%) control patients. • Sixty-eight patients met inclusion criteria, but were not enrolled. Documented reasons included presumed infection, immediate transfer to cardiac catheterization lab, poor baseline function, and withdrawal of care in the ED. • We collected data on a relatively small number of patients. • We obtained data retrospectively by chart review . • Our study was non-randomized. Some patients who met inclusion criteria were not treated based on physician judgment which may have produced a selection bias in our study patients. • Our data was collected from only one institution. • Therapeutic hypothermia has been shown to improve survival and neurologic outcome in patients resuscitated after ventricular fibrillation arrest. • Few studies have examined whether therapeutic hypothermia is effective outside the research setting, or with other presenting rhythms. • Our institution, a large community teaching hospital, instituted a therapeutic hypothermia protocol in November 2006 for all resuscitated cardiac arrest patients. • We sought to determine if our protocol would provide a similar mortality benefit. • Secondarily, we sought to determine if neurological status on discharge would be improved after treatment with therapeutic hypothermia. Conclusions • Neurological outcome on discharge was improved in patients treated with therapeutic hypothermia, but did not reach statistical significance in our small patient cohort. • Mortality rates were not statistically different between groups. A trend towards improved mortality was noted, especially among patients presenting with VF/VT arrest. Methods References • We performed a before-and-after study from November 2006 to December 2010. • Patients were cooled for 24 hours to 33 °C using an Alsius CoolGuard unit and femoral catheter. The same device was then used to re-warm patients at 0.5 °C/hr for 12 hours or until they reached 36.5 °C. • Inclusion criteria were any adult non-pregnant patient who was unresponsive after resuscitation from cardiac arrest regardless of presenting rhythm and who survived to hospital admission. • Exclusion criteria were hypotension (SBP <90), initial temperature < 30 °C, trauma, primary intracranial event, or active coagulopathy. • Historical controls from November 2005 to November 2006 were identified from the electronic medical record, and met the same inclusion and exclusion criteria. • Survival to hospital discharge was our primary outcome measure. • Neuroloical status, determined by Glasgow-Pittsburgh cerebral performance category, was abstracted from the medical records. Category 1 or 2 was rated as good. • Bernard SA et al. Treatment of comatose survivors of out of-hospital cardiac arrest with induced hypothermia. N Engl J Med. 2002; Feb 21;346(8):557-63. • Hypothermia after Cardiac Arrest Study Group. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med. 2002; Feb 21;346(8):549-56. • Therapeutic Hypothermia After Cardiac Arrest: An Advisory Statement by the Advanced Life Support Task Force of the International Liason Committee on Resuscitation. Circulation 2003;108:118-21.