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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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One-year survival of the study population. Kaplan-Meier 1-year survival analysis of both study groups.
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Figure 3: One-year survival of the study population. Kaplan-Meier 1-year survival analysis of both study groups.

Mentions: Likewise, multivariate analysis in the subgroup of survivors identified APACHE II score (P = 0.009) and hypothermia treatment (P = 0.026) as independent predictors of shorter time on mechanical ventilation. The complete results of the multivariate analyses are presented in Table 2. Follow-up data for 1-year survival probability were performed including all patients (n = 126). Kaplan-Meier analysis revealed a probability for 365-day survival of 55.1% (confidence interval [CI] 39.1% to 68.5%) in the hypothermia group compared with 30.8% (CI 19.9% to 42.3%) in the control group. The log-rank test was significant (P = 0.013) (Figure 3).


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)

One-year survival of the study population. Kaplan-Meier 1-year survival analysis of both study groups.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: One-year survival of the study population. Kaplan-Meier 1-year survival analysis of both study groups.
Mentions: Likewise, multivariate analysis in the subgroup of survivors identified APACHE II score (P = 0.009) and hypothermia treatment (P = 0.026) as independent predictors of shorter time on mechanical ventilation. The complete results of the multivariate analyses are presented in Table 2. Follow-up data for 1-year survival probability were performed including all patients (n = 126). Kaplan-Meier analysis revealed a probability for 365-day survival of 55.1% (confidence interval [CI] 39.1% to 68.5%) in the hypothermia group compared with 30.8% (CI 19.9% to 42.3%) in the control group. The log-rank test was significant (P = 0.013) (Figure 3).

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