Comparative Effectiveness of Therapeutic Hypothermia After Out-of-Hospital Cardiac Arrest: Insight from a Large Data Registry.
TLDR
It is concluded that when TH is indiscriminately provided to a large population of OHCA survivors with a nonshockable first documented rhythm, evidence for its effectiveness is diminished and more uniform and rigid guidelines for application are suggested.Abstract:
This study was done to determine the effectiveness of therapeutic hypothermia (TH) after out-of-hospital cardiac arrest (OHCA) among a large cohort of adults in the Cardiac Arrest Registry to Enhance Survival (CARES), with an emphasis on subgroups with a nonshockable first documented rhythm. This was an IRB approved retrospective cohort study. All adult index events at participating sites from November 2010 to December 2013 were study eligible. All patient data elements were provided. Summary statistics were calculated for all patients with and without TH. For multivariate adjustment, a multilevel (i.e., hierarchical), mixed-effects logistic regression (MLR) model was used with hospitals treated as random effects. Propensity score matching (PSM) on both shockable and nonshockable patients was done as a sensitivity analysis. After predefined exclusions, our final sample size was 6369 records for analysis: shockable=2992 (47.0%); asystole=1657 (26.0%); pulseless electrical activity=1249 (19.6%); other unspecified nonshockable=471 (7.4%). Unadjusted differences in neurological status at hospital discharge with and without TH were similar (p=0.295). After multivariate adjustment, TH had either no association with good neurological status at hospital discharge or that TH was actually associated with worse neurological outcome, particularly in patients with a nonshockable first documented rhythm (i.e., for NS patients, MLR odds ratio for TH=1.444; 95% CI [1.039, 2.006] p=0.029, and OR=1.017, p=0.927 via PSM). Highlighting our limitations, we conclude that when TH is indiscriminately provided to a large population of OHCA survivors with a nonshockable first documented rhythm, evidence for its effectiveness is diminished. We suggest more uniform and rigid guidelines for application.read more
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Part 8: Post-cardiac arrest care: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care
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Targeted Temperature Management for Cardiac Arrest with Nonshockable Rhythm
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References
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Journal ArticleDOI
Part 9: Post-Cardiac Arrest Care: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care
Mary Ann Peberdy,Clifton W. Callaway,Robert W. Neumar,Romergryko G. Geocadin,Janice L. Zimmerman,Michael W. Donnino,Andrea Gabrielli,Scott M. Silvers,Arno Zaritsky,Raina M. Merchant,Terry L. Vanden Hoek,Steven L. Kronick +11 more
TL;DR: The goal of immediate post-cardiac arrest care is to optimize systemic perfusion, restore metabolic homeostasis, and support organ system function to increase the likelihood of intact neurological survival.
Journal ArticleDOI
Cardiac arrest and cardiopulmonary resuscitation outcome reports: update and simplification of the Utstein templates for resuscitation registries. A statement for healthcare professionals from a task force of the international liaison committee on resuscitation (American Heart Association, European Resuscitation Council, Australian Resuscitation Council, New Zealand Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa)
Ian N. Jacobs,Vinay M. Nadkarni,J. Bahr,Robert A. Berg,John E. Billi,Leo Bossaert,Pascal Cassan,Ashraf Coovadia,Kate D'Este,Judith Finn,Henry R. Halperin,Anthony J. Handley,Johan Herlitz,Robert W. Hickey,Ahamed H. Idris,Walter Kloeck,Gregory Luke Larkin,Mary E. Mancini,Pip Mason,Gregory Mears,Koenraad G. Monsieurs,William H. Montgomery,Peter T. Morley,Graham Nichol,Jerry P. Nolan,Kazuo Okada,Jeffrey M. Perlman,Michael Shuster,Petter Steen,Fritz Sterz,J. Tibballs,Sergio Timerman,Tanya Lane Truitt,D. Zideman +33 more
TL;DR: A task force of the International Liaison Committee on Resuscitation (ILCOR) met in Melbourne, Australia, to review worldwide experience with the Utstein definitions and reporting templates as mentioned in this paper.
Journal ArticleDOI
Recommended guidelines for uniform reporting of data from out-of-hospital cardiac arrest: the Utstein Style. A statement for health professionals from a task force of the American Heart Association, the European Resuscitation Council, the Heart and Stroke Foundation of Canada, and the Australian Resuscitation Council.
Richard O. Cummins,Douglas Chamberlain,N. Abramson,M. Allen,Peter Baskett,Lance B. Becker,Leo Bossaert,Herman H Delooz,Wolfgang Dick,Mickey Eisenberg +9 more
Journal ArticleDOI
2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.
Journal ArticleDOI
Hypothermia for neuroprotection after cardiac arrest: systematic review and individual patient data meta-analysis.
Michael Holzer,Stephen Bernard,Said Hachimi-Idrissi,Risto O. Roine,Fritz Sterz,Marcus Müllner +5 more
TL;DR: Mild therapeutic hypothermia improves short-term neurologic recovery and survival in patients resuscitated from cardiac arrest of presumed cardiac origin and its long-term effectiveness and feasibility at an organizational level need further research.
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