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‘COOL IT’ MORE OFTEN FOR CARDIAC ARREST

Outcomes for out-of-hospital cardiac arrest (OHCA) could be improved with a comprehensive therapeutic hypothermia (TH) protocol, integrated into regional ST-segment elevation myocardial infarction (STEMI) networks, according to research published recently in Circulation.1

The Cool It protocol established TH as a standard of care in a regional network of hospitals around Minnesota, beginning with basic cooling in the ambulance or local hospital, before transfer to a central TH-capable hospital.  Here the patient’s body temperature is lowered for several hours, maintained at 92ºF for 24 hours, and gradually raised to normal temperature over the next eight hours.

The authors examined data from 140 OHCA patients who, remaining unresponsive after return of spontaneous circulation, were cooled and rewarmed with a TH device between February 2006 and August 2009.  107 of these were transferred to the central TH-capable hospital from referring network hospitals.

cooling insideOverall survivial to discharge was 56%, and 92% of survivors were discharged with a positive neurological outcome. Non–ventricular fibrillation arrest and presence of cardiogenic shock were associated strongly with mortality, but survivors of each had high rates of positive neurological recovery (100% and 89%, respectively).

The protocol also included high-risk patients with nonventricular-fibrillation arrest, those in cardiogenic shock, elderly patients, and those with an extended time between collapse and return of spontaneous circulation, previously excluded from clinical trials of TH.  The authors found that outcomes in these patients were better than expected, in terms of overall survival and neurological outcome.

The authors assert that the target population for TH should be broadened in light of these findings: “We have demonstrated that TH protocols that incorporate simple, noninvasive surface cooling before hospital arrival can provide an effective rescue therapy for OHCA and should readily be adopted within the context of existing STEMI networks.”

References

1 Mooney MR, Unger BT, Boland LL, et al. Therapeutic hypothermia after out-of-hospital cardiac arrest: evaluation of a regional system to increase access to cooling. Circ 2011;124:206-14.

Published on: August 2, 2011

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  • ArrhythmiaAlliance
  • Stars
  • Anticoagulation Europe
  • Atrial Fibrillation Association
 

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