Original Article

Community-Based Application of Mild Therapeutic Hypothermia for Survivors of Cardiac Arrest

Authors: John Prior, DO, Mary Lawhon-Triano, CRNP-C, David Fedor, DO, Vincent J. Vanston, MD, Roger Getts, DO, Raymond A. Smego, Jr., MD, MPH

Abstract


Objective: To demonstrate that the application of therapeutic hypothermia is technically feasible in a community-based setting.


Background: Implementation of therapeutic hypothermia for survivors of cardiac arrest in the United States has been slow, at least partially because of the perception that this therapy is technically difficult, especially at the community level.


Study Design: Retrospective cohort study with historical controls.


Methods: At our three community hospitals and after return of spontaneous circulation (ROSC), survivors of cardiac arrest were treated with therapeutic hypothermia using ice and cooling blankets or suits in order to cool patients to 32°C–34°C within 4 hours to achieve goal temperature within 8 hours and to maintain goal temperature for 24 hours.


Results: Beginning in 2004, 44 survivors of cardiac arrest were managed with therapeutic hypothermia. The mean time from ROSC to initiation of therapeutic hypothermia was 2.8 hours (range, 0.2–7.8 hours), the mean time from ROSC to goal temperature was 7.2 hours (range, 0.8–15.1 hours), and the mean time maintained at goal temperature was 24.5 hours (range, 9–28 hours). Once patients achieved goal temperature, 4.4% of the temperature readings were above 34°C, reflecting undercooling, while 16.4% of the readings were below 32°C, indicative of overcooling. Overall survival until hospital discharge with good neurologic outcome was 43%, compared to only 13% (P < 0.001) among selected controls. There were no major complications directly attributable to the induction of hypothermia or rewarming.


Conclusion: A simple protocol of mild therapeutic hypothermia using locally available resources is technically feasible and safe in a community-based setting.



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