Abstract
Background Therapeutic hypothermia (TH) improves the outcome of comatose patients suffering an out-of-hospital sudden cardiac arrest (SCA) with shockable rhythm and return of spontaneous circulation (ROSC). Evidence supporting its use in other circumstances is weak and the adoption of TH remains limited. Objective Describe the development and implementation of a TH program at an urban public hospital and report outcomes of out-of-hospital and in-hospital SCA and important quality measures. Methods The protocol was developed at 464-bed urban public hospital. We assembled historical and prospective samples of patients suffering an SCA. We measured the neurologic outcome of patients at the time of hospital discharge who underwent TH after SCA. We compared outcomes and important quality measures (duration of arrest, time to cooling, and time to target temperature) to existing literature. We determined reasons for not using TH in patients with in-hospital SCA. Results We described the development of our TH program and the challenges we faced implementing it. Of 45 patients treated with TH after SCA, 23 (51%) survived to discharge, 14 (31%) with good neurologic outcomes. In comparison to historical controls, TH did not improve outcome of in-hospital SCA. SCA from a shockable rhythm was associated with the best outcome. The time from return of spontaneous circulation to initiation of TH was consistently within 8 h. Conclusions Despite logistical and financial constraints, we were able to rapidly implement a TH program with quality and outcomes similar to published data. TH did not improve outcomes for patients with an in-hospital SCA.
Original language | English (US) |
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Pages (from-to) | 40-45 |
Number of pages | 6 |
Journal | Heart and Lung: Journal of Acute and Critical Care |
Volume | 46 |
Issue number | 1 |
DOIs | |
State | Published - Jan 1 2017 |
Keywords
- In-hospital, Out-of hospital
- Multidisciplinary approach
- Sudden cardiac arrest
- Therapeutic hypothermia
ASJC Scopus subject areas
- Pulmonary and Respiratory Medicine
- Critical Care and Intensive Care Medicine
- Cardiology and Cardiovascular Medicine