Posted on 11/01/2013

CHICAGO, IL--There's no difference in neurologic outcomes or survival--as long as cardiac arrest patients are started on therapeutic hypothermia within six hours of being revived, researchers said here.

In a single-center study, those who were started on hypothermia within two hours had similar Cerebral Performance Category (CPC) scores -- a measure of neurologic outcomes -- and similar survival to those whose bodies were cooled more than two hours after they'd been revived, according to Said Chaaban, MD, of Kansas University School Of Medicine in Wichita and colleagues.

But those who were cooled sooner did have a significantly shorter length of stay in the cardiac intensive care unit (ICU), Chaaban reported during a poster session at the CHEST meeting.

"It's just a retrospective review, but if these findings are true, it could mean a huge decrease in medical expenses and comorbidities," Chaaban said.

In therapeutic hypothermia, the body temperature is lowered as quickly as possible, usually via a balloon catheter and cold saline. That temperature is maintained for about 24 hours, followed by a re-warming period until the temperature is normalized.

Chaaban said a number of centers across the U.S. are adopting the procedure to improve outcomes among their out-of-hospital cardiac arrest patients, as more guidelines have started to confirm its utility.

Those guidelines also suggest that the protocol should be started within six hours of return of spontaneous circulation, but the exact timing is unclear.

So Chaaban and colleagues conducted a retrospective study of data from their hospital over a two-year period to determine whether there were differences in outcomes if hypothermia was started within two hours of recovery, or after two hours.

Out of 49 patients, 35 started hypothermia more than two hours after arrest, and 14 started within two hours or less.

If patients did have hypothermia induced earlier, it tended to be done in the emergency department, and this group also achieved a lower body temperature.

Overall, they found no differences in CPC score -- as a measure of neurologic outcome -- or in mortality between these two groups.

However, those who were cooled earlier had a significantly shorter stay in the cardiac ICU, as well as a trend toward a shorter overall length of stay.

Chaaban said the findings suggest that a clinically meaningful neurologic recovery and survival can be achieved whether patients get therapeutic hypothermia "early" or "late" after cardiac arrest -- although he warned that the findings are only retrospective and provide an "idea for more clinical and prospective review."

But if indeed they are true, he said, the therapy has the potential to reduce morbidity associated with longer ICU and hospital stay, including infection and other complications.

Action Points

  • Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
  • In a retrospective review, initiation of therapeutic hypothermia within 2 hours of cardiac arrest showed no differences in patient clinical outcomes when compared to late initiation, but patients in whom hypothermia was initiated earlier had a decreased length of cardiac intensive care unit stay.

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SOURCE: Kristina Fiore, MedPage Today

 

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