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.