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Mild therapeutic hypothermia shortens intensive care unit stay of survivors after out-of-hospital cardiac arrest compared to historical controls.

Storm C, Steffen I, Schefold JC, Krueger A, Oppert M, Jörres A, Hasper D - Crit Care (2008)

Bottom Line: They were compared with a historical cohort (n = 74, median age 63.8 years, 53 males, 43 ventricular fibrillation) treated in the era prior to hypothermia treatment.ICU length of stay and time on ventilator were prolonged in patients with CPC 3 or 4 compared with patients with CPC 1 or 2 (P = 0.003 and P = 0.034, respectively).Moreover, profound improvements in both neurological outcome and 1-year survival were observed.

View Article: PubMed Central - HTML - PubMed

Affiliation: Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Department of Nephrology and Medical Intensive Care Medicine, Augustenburger Platz 1, 13353 Berlin, Germany.

ABSTRACT

Introduction: Persistent coma is a common finding after cardiac arrest and has profound ethical and economic implications. Evidence suggests that therapeutic hypothermia improves neurological outcome in these patients. In this analysis, we investigate whether therapeutic hypothermia influences the length of intensive care unit (ICU) stay and ventilator time in patients surviving out-of-hospital cardiac arrest.

Methods: A prospective observational study with historical controls was conducted at our medical ICU. Fifty-two consecutive patients (median age 62.6 years, 43 males, 34 ventricular fibrillation) submitted to therapeutic hypothermia after out-of-hospital cardiac arrest were included. They were compared with a historical cohort (n = 74, median age 63.8 years, 53 males, 43 ventricular fibrillation) treated in the era prior to hypothermia treatment. All patients received the same standard of care. Neurological outcome was assessed using the Pittsburgh cerebral performance category (CPC) score. Univariate analyses and multiple regression models were used.

Results: In survivors, therapeutic hypothermia and baseline disease severity (Acute Physiology and Chronic Health Evaluation II [APACHE II] score) were both found to significantly influence ICU stay and ventilator time (all P < 0.01). ICU stay was shorter in survivors receiving therapeutic hypothermia (median 14 days [interquartile range (IQR) 8 to 26] versus 21 days [IQR 15 to 30] in the control group; P = 0.017). ICU length of stay and time on ventilator were prolonged in patients with CPC 3 or 4 compared with patients with CPC 1 or 2 (P = 0.003 and P = 0.034, respectively). Kaplan-Meier analysis showed improved probability for 1-year survival in the hypothermia group compared with the controls (log-rank test P = 0.013).

Conclusion: Therapeutic hypothermia was found to significantly shorten ICU stay and time of mechanical ventilation in survivors after out-of-hospital cardiac arrest. Moreover, profound improvements in both neurological outcome and 1-year survival were observed.

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Intensive care unit (ICU) length of stay and time on ventilator in the study groups. Boxplot of ICU length of stay (left) and time on ventilator (right) in survivors of the hypothermia (n = 23) and the control (n = 43) group.
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Figure 1: Intensive care unit (ICU) length of stay and time on ventilator in the study groups. Boxplot of ICU length of stay (left) and time on ventilator (right) in survivors of the hypothermia (n = 23) and the control (n = 43) group.

Mentions: Univariate analysis of ICU LOS for all patients (dead and alive) showed no significant difference between the two groups (P = 0.947). However, if only survivors were analyzed, ICU LOS was significantly lower in the hypothermia group (median 14 days [IQR 8 to 26] versus 21 days [IQR 15 to 30]; P = 0.017) (Figure 1). In contrast to this finding, there was no statistically significant difference regarding ICU LOS in patients who died during ICU stay (median 9 days [IQR 6 to 22] for the hypothermia group and 7 days [IQR 5 to 10] for the control group; P = 0.250).


Mild therapeutic hypothermia shortens intensive care unit stay of survivors after out-of-hospital cardiac arrest compared to historical controls.

Storm C, Steffen I, Schefold JC, Krueger A, Oppert M, Jörres A, Hasper D - Crit Care (2008)

Intensive care unit (ICU) length of stay and time on ventilator in the study groups. Boxplot of ICU length of stay (left) and time on ventilator (right) in survivors of the hypothermia (n = 23) and the control (n = 43) group.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2481476&req=5

Figure 1: Intensive care unit (ICU) length of stay and time on ventilator in the study groups. Boxplot of ICU length of stay (left) and time on ventilator (right) in survivors of the hypothermia (n = 23) and the control (n = 43) group.
Mentions: Univariate analysis of ICU LOS for all patients (dead and alive) showed no significant difference between the two groups (P = 0.947). However, if only survivors were analyzed, ICU LOS was significantly lower in the hypothermia group (median 14 days [IQR 8 to 26] versus 21 days [IQR 15 to 30]; P = 0.017) (Figure 1). In contrast to this finding, there was no statistically significant difference regarding ICU LOS in patients who died during ICU stay (median 9 days [IQR 6 to 22] for the hypothermia group and 7 days [IQR 5 to 10] for the control group; P = 0.250).

Bottom Line: They were compared with a historical cohort (n = 74, median age 63.8 years, 53 males, 43 ventricular fibrillation) treated in the era prior to hypothermia treatment.ICU length of stay and time on ventilator were prolonged in patients with CPC 3 or 4 compared with patients with CPC 1 or 2 (P = 0.003 and P = 0.034, respectively).Moreover, profound improvements in both neurological outcome and 1-year survival were observed.

View Article: PubMed Central - HTML - PubMed

Affiliation: Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Department of Nephrology and Medical Intensive Care Medicine, Augustenburger Platz 1, 13353 Berlin, Germany.

ABSTRACT

Introduction: Persistent coma is a common finding after cardiac arrest and has profound ethical and economic implications. Evidence suggests that therapeutic hypothermia improves neurological outcome in these patients. In this analysis, we investigate whether therapeutic hypothermia influences the length of intensive care unit (ICU) stay and ventilator time in patients surviving out-of-hospital cardiac arrest.

Methods: A prospective observational study with historical controls was conducted at our medical ICU. Fifty-two consecutive patients (median age 62.6 years, 43 males, 34 ventricular fibrillation) submitted to therapeutic hypothermia after out-of-hospital cardiac arrest were included. They were compared with a historical cohort (n = 74, median age 63.8 years, 53 males, 43 ventricular fibrillation) treated in the era prior to hypothermia treatment. All patients received the same standard of care. Neurological outcome was assessed using the Pittsburgh cerebral performance category (CPC) score. Univariate analyses and multiple regression models were used.

Results: In survivors, therapeutic hypothermia and baseline disease severity (Acute Physiology and Chronic Health Evaluation II [APACHE II] score) were both found to significantly influence ICU stay and ventilator time (all P < 0.01). ICU stay was shorter in survivors receiving therapeutic hypothermia (median 14 days [interquartile range (IQR) 8 to 26] versus 21 days [IQR 15 to 30] in the control group; P = 0.017). ICU length of stay and time on ventilator were prolonged in patients with CPC 3 or 4 compared with patients with CPC 1 or 2 (P = 0.003 and P = 0.034, respectively). Kaplan-Meier analysis showed improved probability for 1-year survival in the hypothermia group compared with the controls (log-rank test P = 0.013).

Conclusion: Therapeutic hypothermia was found to significantly shorten ICU stay and time of mechanical ventilation in survivors after out-of-hospital cardiac arrest. Moreover, profound improvements in both neurological outcome and 1-year survival were observed.

Show MeSH
Related in: MedlinePlus