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Out of hospital cardiac arrest (OHCA) is a major cause of unexpected deaths in Singapore with an OHCA survival-to-hospital-discharge rate of 2%. Therapeutic hypothermia is strongly recommended for comatose OHCA survivors. Despite this, worldwide implementation of therapeutic hypothermia has been slow.
We aim to evaluate the effectiveness of protocolizing therapeutic hypothermia in a large tertiary hospital and to describe the outcomes of OHCA following its implementation.
We evaluated 964 OHCA patients who presented to the Emergency Department from April 2010 to July 2012. A protocol for therapeutic hypothermia was implemented in June 2011. Data on patients' demographics, initial rhythm of arrest, site of care, institution of therapeutic hypothermia, and neurological outcome on discharge were collected.
From April 2010 to July 2012, 964 OHCA patients presented to the Emergency Department and 160 patients survived to admission. The overall OHCA survival-to-hospital-discharge rate was 3.4%; this rate was 2.0% in the first year and 5.1% in the year following the implementation of a protocol (p value = 0.014).
Younger age (odds ratio=0.66 per 10 years, p=0.003) and a presenting rhythm of ventricular fibrillation/tachycardia (odds ratio=7.13, p≤0.001) were strong predictors of survival to discharge.
The overall rate of implementation of therapeutic hypothermia was 25.8%. Prior to the implementation of a protocol in June 2011, only 8.8% of patients who survived to admission had therapeutic hypothermia. This rate increased significantly to 35.7% in the year following the implementation of a protocol (p value≤0.001).
A greater proportion of the patients in the hypothermia group were discharged with good neurological outcome (15% versus 7.8%, p value = 0.217), although the result was not statistically significant.
The presence of a protocol led to increasing use of therapeutic hypothermia for comatose OHCA patients in our intensive care units and may have contributed to an improvement in the outcomes of OHCA patients.
- 2013 American College of Cardiology Foundation