Neurological Benefit of Therapeutic Hypothermia Following Return of Spontaneous Circulation for Out-of-Hospital Non-Shockable Cardiac Arrest

Taketomo Soga; Ken Nagao; Hirotaka Sawano; Hiroyuki Yokoyama; Yoshio Tahara; Mamoru Hase; Takayuki Otani; Shinichi Shirai; Hiroshi Hazui; Hideki Arimoto; Kazunori Kashiwase; Shunji Kasaoka; Tomokazu Motomura; Yasuhiro Kuroda; Yuji Yasuga; Naohiro Yonemoto; Hiroshi Nonogi; for the J-PULSE-Hypo Investigators

doi:10.1253/circj.CJ-12-0448

Critical Care

Neurological Benefit of Therapeutic Hypothermia Following Return of Spontaneous Circulation for Out-of-Hospital Non-Shockable Cardiac Arrest

Taketomo Soga, Ken Nagao, Hirotaka Sawano, Hiroyuki Yokoyama, Yoshio Tahara, Mamoru Hase, Takayuki Otani, Shinichi Shirai, Hiroshi Hazui, Hideki Arimoto, Kazunori Kashiwase, Shunji Kasaoka, Tomokazu Motomura, Yasuhiro Kuroda, Yuji Yasuga, Naohiro Yonemoto, Hiroshi Nonogi, for the J-PULSE-Hypo Investigators

Author information

Taketomo Soga
Department of Cardiology, Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, Surugadai Nihon University Hospital
Ken Nagao
Department of Cardiology, Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, Surugadai Nihon University Hospital
Hirotaka Sawano
Senri Critical Care Medical Center, Saiseikai Senri Hospital
Hiroyuki Yokoyama
National Cerebral and Cardiovascular Center
Yoshio Tahara
Critical Care and Emergency Medical Center, Yokohama City University Medical Center
Mamoru Hase
Emergency and Critical Care Center, Sapporo City University Hospital
Takayuki Otani
Hiroshima City Hospital
Shinichi Shirai
Division of Cardiology, Kokura Memorial Hospital
Hiroshi Hazui
Emergency Medicine, Osaka Mishima Emergency and Critical Care Center
Hideki Arimoto
Emergency and Critical Care Medical Center, Osaka City General Hospital
Kazunori Kashiwase
Division of Cardiology, Osaka Police Hospital
Shunji Kasaoka
Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital
Tomokazu Motomura
Department of Emergency Medicine, Saga University Hospital
Yasuhiro Kuroda
Emergency and Critical Care Center, Kagawa University Hospital
Yuji Yasuga
Department of Cardiology, Sumitomo Hospital
Naohiro Yonemoto
Department of Epidemiology and Biostatistics, National Center of Neurology and Psychiatry
Hiroshi Nonogi
National Cerebral and Cardiovascular Center
for the J-PULSE-Hypo Investigators

Keywords: Cardiac arrest, Non-shockable rhythm, Post cardiac arrest care, Resuscitation, Therapeutic hypothermia

JOURNAL FREE ACCESS

2012 Volume 76 Issue 11 Pages 2579-2585

DOI https://doi.org/10.1253/circj.CJ-12-0448

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Abstract

Background: Although therapeutic hypothermia is an effective therapy for comatose adults experiencing out-of-hospital shockable cardiac arrest, there is insufficient evidence that is also applicable for those with out-of-hospital non-shockable cardiac arrest. Methods and Results: Of 452 comatose adults treated with therapeutic hypothermia after return of spontaneous circulation (ROSC) subsequent to an out-of-hospital cardiac arrest of cardiac etiology, 372 who had a bystander-witnessed cardiac arrest, target core temperature of 32–34°C and cooling duration of 12–72h were eligible for this study (75 cases of non-shockable cardiac arrest, 297 cases of shockable cardiac arrest). The median collapse-to-ROSC interval was significantly longer in the non-shockable group than in the shockable group (30min vs. 22min, P=0.008), resulting in a significantly lower frequency of 30-day favorable neurological outcome in the non-shockable group compared with the shockable group (32% vs. 66%, P<0.001). However, an analysis of data in quartiles assigned to varying lengths of collapse-to-ROSC interval revealed a similar frequency of 30-day favorable neurological outcome among both groups when the collapse-to-ROSC interval was ≤16min (90% non-shockable group vs. 92% shockable group; odds ratio 0.80, 95% confidence interval 0.09–7.24, P=0.84). Conclusions: Post-ROSC cooling is an effective treatment for patients with non-shockable cardiac arrest when the time interval from collapse to ROSC is short. (Circ J 2012; 76: 2579–2585)

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