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Association Between Therapeutic Hypothermia and Survival After In-Hospital Cardiac Arrest.
- Source :
-
JAMA: Journal of the American Medical Association . 10/4/2016, Vol. 316 Issue 13, p1375-1382. 8p. 1 Diagram, 3 Charts. - Publication Year :
- 2016
-
Abstract
- <bold>Importance: </bold>Therapeutic hypothermia is used for patients following both out-of-hospital and in-hospital cardiac arrest. However, randomized trials on its efficacy for the in-hospital setting do not exist, and comparative effectiveness data are limited.<bold>Objective: </bold>To evaluate the association between therapeutic hypothermia and survival after in-hospital cardiac arrest.<bold>Design, Setting, and Patients: </bold>In this cohort study, within the national Get With the Guidelines-Resuscitation registry, 26 183 patients successfully resuscitated from an in-hospital cardiac arrest between March 1, 2002, and December 31, 2014, and either treated or not treated with hypothermia at 355 US hospitals were identified. Follow-up ended February 4, 2015.<bold>Exposure: </bold>Induction of therapeutic hypothermia.<bold>Main Outcomes and Measures: </bold>The primary outcome was survival to hospital discharge. The secondary outcome was favorable neurological survival, defined as a Cerebral Performance Category score of 1 or 2 (ie, without severe neurological disability). Comparisons were performed using a matched propensity score analysis and examined for all cardiac arrests and separately for nonshockable (asystole and pulseless electrical activity) and shockable (ventricular fibrillation and pulseless ventricular tachycardia) cardiac arrests.<bold>Results: </bold>Overall, 1568 of 26 183 patients with in-hospital cardiac arrest (6.0%) were treated with therapeutic hypothermia; 1524 of these patients (mean [SD] age, 61.6 [16.2] years; 58.5% male) were matched by propensity score to 3714 non-hypothermia-treated patients (mean [SD] age, 62.2 [17.5] years; 57.1% male). After adjustment, therapeutic hypothermia was associated with lower in-hospital survival (27.4% vs 29.2%; relative risk [RR], 0.88 [95% CI, 0.80 to 0.97]; risk difference, -3.6% [95% CI, -6.3% to -0.9%]; P = .01), and this association was similar (interaction P = .74) for nonshockable cardiac arrest rhythms (22.2% vs 24.5%; RR, 0.87 [95% CI, 0.76 to 0.99]; risk difference, -3.2% [95% CI, -6.2% to -0.3%]) and shockable cardiac arrest rhythms (41.3% vs 44.1%; RR, 0.90 [95% CI, 0.77 to 1.05]; risk difference, -4.6% [95% CI, -10.9% to 1.7%]). Therapeutic hypothermia was also associated with lower rates of favorable neurological survival for the overall cohort (hypothermia-treated group, 17.0% [246 of 1443 patients]; non-hypothermia-treated group, 20.5% [725 of 3529 patients]; RR, 0.79 [95% CI, 0.69 to 0.90]; risk difference, -4.4% [95% CI, -6.8% to -2.0%]; P < .001) and for both rhythm types (interaction P = .88).<bold>Conclusions and Relevance: </bold>Among patients with in-hospital cardiac arrest, use of therapeutic hypothermia compared with usual care was associated with a lower likelihood of survival to hospital discharge and a lower likelihood of favorable neurological survival. These observational findings warrant a randomized clinical trial to assess efficacy of therapeutic hypothermia for in-hospital cardiac arrest. [ABSTRACT FROM AUTHOR]
- Subjects :
- *THERAPEUTIC hypothermia
*CARDIAC arrest
*HYPOTHERMIA
*HEART diseases
*CLINICAL trials
*THERAPEUTICS
*COMPARATIVE studies
*INDUCED hypothermia
*LONGITUDINAL method
*RESEARCH methodology
*MEDICAL cooperation
*PROBABILITY theory
*RESEARCH
*RESEARCH funding
*SURVIVAL analysis (Biometry)
*TIME
*EVALUATION research
*DISCHARGE planning
*TREATMENT effectiveness
*ACQUISITION of data
*HOSPITAL mortality
Subjects
Details
- Language :
- English
- ISSN :
- 00987484
- Volume :
- 316
- Issue :
- 13
- Database :
- Academic Search Index
- Journal :
- JAMA: Journal of the American Medical Association
- Publication Type :
- Academic Journal
- Accession number :
- 118651704
- Full Text :
- https://doi.org/10.1001/jama.2016.14380