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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 and neurological outcome. Boxplot of ICU length of stay (left) and time on ventilator (right) of the study population (n = 126) according to the neurological outcome assessed as cerebral performance category (CPC).
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Figure 2: Intensive care unit (ICU) length of stay and time on ventilator and neurological outcome. Boxplot of ICU length of stay (left) and time on ventilator (right) of the study population (n = 126) according to the neurological outcome assessed as cerebral performance category (CPC).

Mentions: C-reactive protein, leukocyte count, and radiological diagnosis of early-onset pneumonia on day 3 were not statistically different between the groups (Table 1). With regard to the neurological outcome, both ICU LOS and time on ventilator were significantly longer in patients with a CPC 3 or 4 compared with patients with CPC 1 or 2 (P = 0.003 for LOS and P = 0.034 for ventilator time) (Figure 2). Hypothermia treatment was associated with significantly improved neurological outcome assessed by CPC 1 or 2 versus 3 or 4 (P < 0.001). The results of the univariate analysis are summarized in Table 1.


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 and neurological outcome. Boxplot of ICU length of stay (left) and time on ventilator (right) of the study population (n = 126) according to the neurological outcome assessed as cerebral performance category (CPC).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: Intensive care unit (ICU) length of stay and time on ventilator and neurological outcome. Boxplot of ICU length of stay (left) and time on ventilator (right) of the study population (n = 126) according to the neurological outcome assessed as cerebral performance category (CPC).
Mentions: C-reactive protein, leukocyte count, and radiological diagnosis of early-onset pneumonia on day 3 were not statistically different between the groups (Table 1). With regard to the neurological outcome, both ICU LOS and time on ventilator were significantly longer in patients with a CPC 3 or 4 compared with patients with CPC 1 or 2 (P = 0.003 for LOS and P = 0.034 for ventilator time) (Figure 2). Hypothermia treatment was associated with significantly improved neurological outcome assessed by CPC 1 or 2 versus 3 or 4 (P < 0.001). The results of the univariate analysis are summarized in Table 1.

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