ISSN 2996-8215
International Journal of Cardiology | Vol. 1, No. 12, December 2010 | pp. 89–96
DOI: 10.46882/2010/IJC/000021
Original Research Article
Therapeutic Hypothermia After Out-of-Hospital Cardiac Arrest: Impact of Early vs. Delayed Initiation on Neurological Outcomes
Lucas Meyer¹, Stefan Kaufmann¹, Dieter Weber²
¹Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
²Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
Abstract:
Therapeutic hypothermia (TH) improves survival and neurological recovery in patients resuscitated from out-of-hospital cardiac arrest (OHCA). However, the optimal timing for initiating cooling remains controversial. This study evaluated whether early pre-hospital initiation of TH improves neurological outcomes compared with delayed in-hospital initiation. We conducted a prospective cohort study of 240 comatose adult patients resuscitated from OHCA with an initial shockable rhythm. Patients were divided into two groups: the early cooling group (n = 112), where cold intravenous saline (4°C) was initiated in the pre-hospital setting by emergency medical services, and the delayed cooling group (n = 128), where cooling was initiated exclusively after intensive care unit (ICU) admission. The primary endpoint was a favorable neurological outcome at 6 months, defined as a Cerebral Performance Category (CPC) score of 1 or 2. The target temperature of 33°C was reached significantly faster in the early cooling group than in the delayed group (185 ± 42 minutes vs. 248 ± 55 minutes from resuscitation, p < 0.001). At 6 months, 54.5% of patients in the early cooling group achieved a favorable neurological outcome compared with 41.4% in the delayed cooling group (p = 0.04). Multivariable logistic regression confirmed that early cooling initiation was an independent predictor of good neurological recovery (odds ratio: 1.68, 95% CI: 1.02–2.76, p = 0.03). Rates of rearrest, severe infection, and bleeding did not differ significantly between the cohorts. Pre-hospital initiation of therapeutic hypothermia safely reduces the time to target temperature and significantly improves 6-month neurological outcomes in comatose survivors of OHCA.
Keywords: Therapeutic hypothermia, Out-of-hospital cardiac arrest, Neurological outcome, Resuscitation, Pre-hospital care
Received: September 01, 2010; Revised: October 14, 2010; Accepted: November 05, 2010; Published: December 15, 2010
Citation: International Journal of Cardiology, 2010, Vol. 1, No. 12, pp. 89–96, DOI: 10.46882/2010/IJC/000021