Yeung AWT, Yan WW, Leung AKH, Chow FL, Polly Tsai, Chan HS, Luk MC; Critical Care and Shock on August 28, 2013

Background:  Previous  studies  showed  that  therapeutic hypothermia after out-of-hospital ventricular fibrillation
arrest significantly improved neurological outcome and survival. This retrospective case series aims to examine
the practice of therapeutic hypothermia in resuscitated post cardiac arrest patients in Hong Kong.

Methods:  Post  cardiac  arrest  patients  with  therapeutic hypothermia  in  six  local  ICUs  from  January  2007
to  June  2012  were  identified.  Baseline  demographic characteristics, clinical data on the cardiac arrest, cooling
profile  and  patient  outcomes  were  recorded.  Statistical analyses  were  performed  to  identify  factors  associated
with good neurological outcome at hospital discharge.

Results: 117 patients underwent therapeutic hypothermia within  the  aforementioned  time  period.  Majority  was
out-of-hospital  arrest  (75.2%)  and  male  (70.1%).  The median age was 59. The initial presenting cardiac rhythm
was shockable in 59.0%. Thirty-two point two percents of the patients enjoyed good neurological outcome. The
hospital mortality was 49.6%. The median cooling rate and time from regain of spontaneous circulation (ROSC)
to target temperature were 0.50°C/hour and 6.5 hours respectively.  Multivariate  logistic  regression  analysis
revealed that an older age, a longer downtime and a higher blood  glucose  range  during  therapeutic  hypothermia
had a reduced odds ratio for good neurological outcome while a shockable presenting rhythm was the strongest
independent  predictor  for  good  neurological  outcome (OR 34.25, 95% CI 5.30-221.22, p<0.001).

Conclusions:  Therapeutic  hypothermia  is  probably underutilized  in  Hong  Kong.  It  is  most  beneficial  for
patients  with  an  initial  shockable  rhythm.  In  future practice,  more  attention  should  be  paid  in  attaining
rapid  cooling,  maintaining  tight  temperature  and glucose control.

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