Anest. intenziv. Med. 2011;22(4):216-226

Does mild therapeutic hypothermia have the same influence on patients' neurological outcome following in-hospital and out-of-hospital resuscitation due to shockable and non-shockable rhythms?Intensive Care Medicine - Original Paper

Fiala Hynek^1,*, Berta Emil², Gabrhelík Tomáš¹, Šafránek Petr¹

¹ Klinika anesteziologie, resuscitace a intenzivní medicíny Fakultní nemocnice Olomouc

² Dept. of Anesthesia and Intensive Care, Ringerike Hospital (Vestre Viken HF), Hønefoss, Norway

Objective:
To assess the impact of therapeutic hypothermia on patients' neurological outcome after out-of- and in-hospital cardiopulmonary resuscitation for shockable and non-shockable rhythms.

Design:
A comparative, non-randomized study.


Setting:
A University Hospital ICU.

Methods:
We compared a group of patients admitted to the ICU following cardiopulmonary resuscitation in 2010 to a group of patients admitted in 2006. Both groups were further divided into two subgroups: resuscitated for shockable and non-shockable rhythms respectively. Neurological outcome was assessed on discharge from the ICU or the hospital by the Glasgow Outcome Scale.

Results:
Compared to 2006, mortality increased in the 2010 subgroups and the number of patients with favourable neurological outcome decreased. In the subgroup of patients receiving out-of-hospital CPR due to VF the mortality increased by 21% and 17% fewer patients were discharged with GOS 4-5. In the subgroup of patients receiving CPR due to asystole the mortality increased by 59% and 11% fewer patients were discharged with GOS 4-5. After in-hospital CPR due to shockable and non-shockable rhythms the mortality increased by 43% and 38% respectively. Regardless of rhythm, 19% fewer patients were discharged with GOS 4-5.

Conclusion:
In contrast to studies by other authors we did not find a benefit of therapeutic hypothermia on the neurological outcome of patients after resuscitation for shockable rhythm. It was confirmed that the neurological outcome of patients after resuscitation for non-shockable rhythm was either unchanged or worse in 2010. This effect may have been influenced by mistakes made when performing therapeutic hypothermia.

Keywords: cardiopulmonary resuscitation; shockable rhythm; non-shockable rhythm; herapeutic hypothermia; body temperature; neurological outcome

Received: March 18, 2011; Accepted: June 20, 2011; Published: August 1, 2011  Show citation