The Outcome and Predictors of Mortality in Patients Therapeutically Cooled Postcardiac Arrest

J Intensive Care Med. 2016 Oct;31(9):603-10. doi: 10.1177/0885066614566792. Epub 2015 Jan 8.

Abstract

Purpose: To review the outcomes of patients postcardiac arrest admitted to a metropolitan intensive care unit (ICU) where therapeutic hypothermia is practiced.

Materials and methods: Patients admitted from 2004 to 2012 were reviewed. The management protocol included cooling to 33°C for 24 hours. The primary outcome assessed was hospital mortality. Secondary outcome measures included mortality in patients admitted to ICU after in-hospital cardiac arrest (IHCA) when compared to those with out-of-hospital cardiac arrest (OHCA) and to review initial cardiac rhythm as an indicator of mortality.

Results: A total of 330 patients were included. The overall hospital mortality was 58.1%. Hospital mortality was significantly higher in patients who had OHCA when compared to IHCA (62.5% vs 51%; P = .04). Patients who had asystole and pulseless electrical activity (PEA) had a higher mortality when compared to ventricular tachycardia/ventricular fibrillation (VT/VF) arrest (81.7% vs 67.8% vs 41.9%, respectively; P < .01).

Conclusion: Patients admitted to ICU postcardiac arrest after therapeutic cooling have a high mortality. An initial rhythm of VT/VF confers a mortality benefit when compared to asystole and PEA.

Keywords: asystole; cardiac arrest; hypothermia; pulseless electrical activity; ventricular fibrillation.

MeSH terms

  • Aged
  • Cardiopulmonary Resuscitation / methods*
  • Cardiopulmonary Resuscitation / mortality
  • Emergency Medical Services*
  • Female
  • Heart Arrest / mortality*
  • Heart Arrest / physiopathology
  • Heart Arrest / therapy
  • Hospital Mortality* / trends
  • Humans
  • Hypothermia, Induced / adverse effects
  • Hypothermia, Induced / methods*
  • Hypothermia, Induced / mortality
  • Intensive Care Units*
  • Male
  • Middle Aged
  • Outcome Assessment, Health Care
  • Retrospective Studies
  • Survival Analysis