Characteristics and outcome of patients with hypothermic out-of-hospital cardiac arrest: Experience from a European trauma center. (November 2017)

• Record Type: Journal Article
• Authors: Ruttmann, Elfriede; Dietl, Marion; Kastenberger, Tobias; El Attal, Rene; Ströhle, Mathias; Ulmer, Hanno; Mair, Peter
• Is Part Of: Resuscitation. Volume 120(2017)
• Page Start: 57
• Page End: 62
• Publication Date: 2017-11
• Subjects: Hypothermia -- Out-of-hospital cardiac arrest -- Outcome -- Extracorporeal life support -- CT scan -- Restoration of spontaneous circulation; Resuscitation -- Periodicals; Resuscitation -- Periodicals; Réanimation -- Périodiques; Electronic journals; 616.025
• DOI: 10.1016/j.resuscitation.2017.08.242
• Languages: English
• ISSNs: 0300-9572

Abstract

Abstract: Background: Aim of the study was to investigate patient characteristics, survival rates and neurological outcome among hypothermic patients with out-of-hospital cardiac arrest (OHCA) admitted to a trauma center. Methods: A review of patients with OHCA and a core temperature ≤32 °C admitted to a trauma center between 2004 and 2016. Results: Ninety-six patients (mean temperature 25.8 °C ± 3.9 °C) were entered in the study, 37 (39%) of them after avalanche burial. 47% showed return of spontaneous circulation (ROSC) prior to hospital admission. Survival with Glasgow-Pittsburgh Cerebral Performance Category (CPC) scale 1 or 2 was achieved in 25% of all patients and was higher in non-avalanche than in avalanche cases (35.6% vs 8.1%, p = 0.002). Witnessed cardiac arrest was the most powerful predictor of favourable neurological outcome (RR: 10.8; 95% Confidence Interval: 3.2–37.1; Wald: 14.3; p < 0.001), whereas ROSC prior to admission and body core temperature were not associated with survival with favourable neurological outcome. Cerebral CT scan pathology within 12 h of admission increased the risk for unfavourable neurological outcome 11.7 fold (RR: 11.7; 95% CI: 3.1–47.5; p < 0.001). Favourable neurological outcome was associated lower S 100-binding protein (0.69 ± 0.5 μg/l vs 5.8 ± 4.9 μg/l, p 0.002) and neuron-specific enolase (34.7 ± 14.2 μg/l vs 88.4 ± 42.7 μg/l, p 0.004) concentrations on intensive care unit (ICU) admission. Conclusions: Survival with favourable neurological outcome was found in about a third of all hypothermic non-avalanche patients with OHCA admitted to a trauma center.