Therapeutic Hypothermia: Implementation and Disposition Outcomes at a Tertiary Care Institution

Aasim Afzal, MBA; Jamil Alsahhar; Adam Mora

PURPOSE: Cardiac arrest is a common cause of in hospital and out of hospital mortality. It commonly causes severe neurological impairment leading to high mortality rates. Hypothermia has been shown to improve neurological recovery and decrease mortality in out of hospital ventricular fibrillation and ventricular tachycardia patients. The purpose of our study is to review the implementation of hypothermia at a tertiary care facility. Data was collected to determine the benefit of hypothermia protocol, compliance with the inclusion and exclusion criteria, difference in mortality rates for in-hospital versus out-of-hospital arrests, and mortality rates in shockable versus non-shockable rhythms.

METHODS: This is a single center systematic review of data collected from 2011-2013 on patients admitted with cardiac arrest and considered as potential candidates for therapeutic hypothermia (TH). Audits were performed on all patients who presented to the emergency department after cardiac arrest and were considered for hypothermia protocol. Audits were also performed on in-hospital cardiac arrests who required mechanical ventilation.

RESULTS: Three hundred and fifty three patient charts were reviewed and 67(18.9%) were initiated on TH. Of those, 26 patients had V-tach/V-fib arrest while 39 patients had PEA/asystole. Of the V-tach/V-fib patients, 69% expired, 23% went home, and 7.7% were sent to SNF. Of the PEA/asystole patients 89.7% expired, 7.6% went home and 2.5% went to SNF. Interestingly, 43% of patients cooled met the inclusion criteria while 57% did not. The most common inclusion criteria that cooled patients failed to meet was hypotension defined as systolic blood pressure (SBP) <90mmHg.

CONCLUSIONS: Hypothermia protocol improves neurological outcome (defined as discharge to SNF or home). Further education and exposure is needed for the physicians and nursing staff to increase the implementation of the hypothermia protocol. Compliance is difficult to measure as it is unknown how many patients were never considered for TH.

Chest. 2014;146(4_Meeting