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Use of Therapeutic Hypothermia After In-Hospital Cardiac Arrest*

Mikkelsen, Mark E. MD, MSCE1,2; Christie, Jason D. MD, MSCE1,2; Abella, Benjamin S. MD, MPhil1,3; Kerlin, Meeta Prasad MD, MSCE1; Fuchs, Barry D. MD1; Schweickert, William D. MD1; Berg, Robert A. MD4; Mosesso, Vincent N. MD5; Shofer, Frances S. PhD3; Gaieski, David F. MD3for the American Heart Association’s Get With the Guidelines-Resuscitation Investigators

doi: 10.1097/CCM.0b013e318287f2c4
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Objectives: Formal guidelines recommend that therapeutic hypothermia be considered after in-hospital cardiac arrest. The rate of therapeutic hypothermia use after in-hospital cardiac arrest and details about its implementation are unknown. We aimed to determine the use of therapeutic hypothermia for adult in-hospital cardiac arrest, whether use has increased over time, and to identify factors associated with its use.

Design: Multicenter, prospective cohort study.

Setting: A total of 538 hospitals participating in the Get With the Guidelines-Resuscitation database (2003–2009).

Patients: A total of 67,498 patients who had return of spontaneous circulation after in-hospital cardiac arrest.

Interventions: None.

Measurements and Main Results: The primary outcome was the initiation of therapeutic hypothermia. We measured the proportion of therapeutic hypothermia patients who achieved target temperature (32–34°C) and were overcooled. Of 67,498 patients, therapeutic hypothermia was initiated in 1,367 patients (2.0%). The target temperature (32–34°C) was not achieved in 44.3% of therapeutic hypothermia patients within 24 hours and 17.6% were overcooled. The use of therapeutic hypothermia increased from 0.7% in 2003 to 3.3% in 2009 (p < 0.001). We found that younger age (p < 0.001) and occurrence in a non-ICU location (p < 0.001), on a weekday (p = 0.005), and in a teaching hospital (p = 0.001) were associated with an increased likelihood of therapeutic hypothermia being initiated.

Conclusions: After in-hospital cardiac arrest, therapeutic hypothermia was used rarely. Once initiated, the target temperature was commonly not achieved. The frequency of use increased over time but remained low. Factors associated with therapeutic hypothermia use included patient age, time and location of occurrence, and type of hospital.

1 Pulmonary, Allergy, and Critical Care Division, Department of Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA.

2 Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA.

3 Department of Emergency Medicine, Center for Resuscitation Science, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA.

4 Children’s Hospital of Philadelphia, Philadelphia, PA.

5 University of Pittsburgh School of Medicine, Pittsburgh, PA.

*See also p. 1565.

Drs. Mikkelsen, Christie, Abella, Fuchs, Schweickert, Berg, and Gaieski helped in conception and design and data collection. They requested to use the American Heart Association’s Get With the Guidelines-Resuscitation (formerly the National Registry of Cardiopulmonary Resuscitation) database. Drs. Mikkelsen, Christie, Abella, Kerlin, Fuchs, Schweickert, Berg, Mosesso, Shofer, and Gaieski contributed to analysis and interpretation of the data and drafting of the manuscript. Dr. Mikkelsen had full access to all the data in the study and took responsibility for the integrity of the data and the accuracy of the data analysis.

Dr. Mikkelsen received grant support from the National Institutes of Health (NIH Loan Repayment Program Award and Renewal Award). Dr. Christie received grant support from Multiple R01 (a genetic ACI grant). Dr. Abella received grant support from NHLBI, Philips, Medtronic Foundation, and Medivance. Dr. Kerlin’s institution has a pending grant application with NHLBI and received funding from CDC for ongoing research. Dr. Mosesso received grant support from Zoll Lifecor Corp.

Dr. Mikkelsen is the site investigator for a NIH sponsored multicenter trial of acute respiratory failure (U01 NIH NHLBI multi-center trial of sepsis-related ALI).Dr. Abella has consulted for HeartSine and Velomedix. Dr. Schweickert has consulted for the Hill ROM-advisory board.Dr. Mosesso provides expert testimony for various legal firms.

Dr. Schweickert received support for manuscript preparation from the American College of Chest Physicians. Dr. Schweickert lectured for Yale University and Thomas Jefferson University.Dr. Mosesso received travel support from the American Board of EM, National Association of EMTs, American Heart Association, and Sudden Cardiac Arrest Association.

Dr. Berg serves as chair for the Get WithThe Guidelines-Resuscitation Clinical Working Group. Dr. Mosesso has medical advisory board membership with OxySure Systems, Inc. Dr. Mosesso serves as the medical director and honorary board member for the Sudden Cardiac Arrest Association.The remaining authors have disclosed that they do not have any potential conflicts of interest.

Presented, in part, at the Society of Critical Care Medicine Congress, Houston, TX, 2012.

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© 2013 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins