Factors predicting the use of therapeutic hypothermia and survival in unconscious out-of-hospital cardiac arrest patients admitted to the ICU
Therapeutic hypothermia (TH) after out-of-hospital cardiac arrest (OHCA) was adopted early in Norway. Since 2004 the general recommendation has been to cool all unconscious OHCA patients treated in the intensive care unit (ICU), but the decision to cool individual patients was left to the responsibl...
Gespeichert in:
| Veröffentlicht in: | Critical care (London, England) England), 2013-07, Vol.17 (4), p.R147-R147, Article R147 |
|---|---|
| Hauptverfasser: | , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | R147 |
|---|---|
| container_issue | 4 |
| container_start_page | R147 |
| container_title | Critical care (London, England) |
| container_volume | 17 |
| creator | Lindner, T W Langørgen, J Sunde, K Larsen, A I Kvaløy, J T Heltne, J K Draegni, T Søreide, E |
| description | Therapeutic hypothermia (TH) after out-of-hospital cardiac arrest (OHCA) was adopted early in Norway. Since 2004 the general recommendation has been to cool all unconscious OHCA patients treated in the intensive care unit (ICU), but the decision to cool individual patients was left to the responsible physician. We assessed factors that were associated with use of TH and predicted survival.
We conducted a retrospective observational study of prospectively collected cardiac arrest and ICU registry data from 2004 to 2008 at three university hospitals.
A total of 715 unconscious patients older than 18 years of age, who suffered OHCA of both cardiac and non-cardiac causes, were included. With an overall TH use of 70%, the survival to discharge was 42%, with 90% of the survivors having a favourable cerebral outcome. Known positive prognostic factors such as witnessed arrest, bystander cardio pulmonary resuscitation (CPR), shockable rhythm and cardiac origin were all positive predictors of TH use and survival. On the other side, increasing age predicted a lower utilisation of TH: Odds Ratio (OR), 0.96 (95% CI, 0.94 to 0.97); as well as a lower survival: OR 0.96 (95% CI, 0.94 to 0.97). Female gender was also associated with a lower use of TH: OR 0.65 (95% CI, 0.43 to 0.97); and a poorer survival: OR 0.57 (95% CI, 0.36 to 0.92). After correcting for other prognostic factors, use of TH remained an independent predictor of improved survival with OR 1.91 (95% CI 1.18-3.06; P |
| doi_str_mv | 10.1186/cc12826 |
| format | Article |
| fullrecord | <record><control><sourceid>gale_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_4057368</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A534778072</galeid><sourcerecordid>A534778072</sourcerecordid><originalsourceid>FETCH-LOGICAL-c502t-47ee7c9d4858076c58d01e9df758ebc952ba53306a229ff64c509c1d21259e7a3</originalsourceid><addsrcrecordid>eNptks2KFDEQxxtR3HUV30ACHvTSaz466fRFWAZXFxa8uOAt1CTVM5HuTpukB_YhfGfTzri4IDmkKvWrf6qKqqrXjF4yptUHaxnXXD2pzlmjVK1o9_1psYVqai2FPKtepPSDUtZqJZ5XZ1xoTRmV59Wva7A5xETmiM7b7KcdyXskS0IS-tWMMOOSvSX7-zms_uiBwORIWuLBH2AgfiLLZMOUrA9LImHJdejrfUizzyVsIToPlkCMmDKZIXucciLgRp8zOpLDny9vNncvq2c9DAlfne6L6u7607fNl_r26-ebzdVtbSXluW5axNZ2rtFS01ZZqR1l2Lm-lRq3tpN8C1IIqoDzru9VU9I6yxxnXHbYgrioPh5152U7orOlngiDmaMfId6bAN48jkx-b3bhYBoqW6F0EXh_Eojh51LaMqNPFocBJiwzMEw2ZdJSUV7Qt0d0BwMaP_WhKNoVN1dSNG1bWlipy_9Q5TgcfZkt9r68P0p4d0ywMaQUsX-onlGz7oQ57UQh3_zb7AP3dwnEb-yds8w</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1548635602</pqid></control><display><type>article</type><title>Factors predicting the use of therapeutic hypothermia and survival in unconscious out-of-hospital cardiac arrest patients admitted to the ICU</title><source>MEDLINE</source><source>DOAJ Directory of Open Access Journals</source><source>Springer Nature OA Free Journals</source><source>EZB-FREE-00999 freely available EZB journals</source><source>PubMed Central</source><source>Alma/SFX Local Collection</source><source>SpringerLink Journals - AutoHoldings</source><creator>Lindner, T W ; Langørgen, J ; Sunde, K ; Larsen, A I ; Kvaløy, J T ; Heltne, J K ; Draegni, T ; Søreide, E</creator><creatorcontrib>Lindner, T W ; Langørgen, J ; Sunde, K ; Larsen, A I ; Kvaløy, J T ; Heltne, J K ; Draegni, T ; Søreide, E</creatorcontrib><description>Therapeutic hypothermia (TH) after out-of-hospital cardiac arrest (OHCA) was adopted early in Norway. Since 2004 the general recommendation has been to cool all unconscious OHCA patients treated in the intensive care unit (ICU), but the decision to cool individual patients was left to the responsible physician. We assessed factors that were associated with use of TH and predicted survival.
We conducted a retrospective observational study of prospectively collected cardiac arrest and ICU registry data from 2004 to 2008 at three university hospitals.
A total of 715 unconscious patients older than 18 years of age, who suffered OHCA of both cardiac and non-cardiac causes, were included. With an overall TH use of 70%, the survival to discharge was 42%, with 90% of the survivors having a favourable cerebral outcome. Known positive prognostic factors such as witnessed arrest, bystander cardio pulmonary resuscitation (CPR), shockable rhythm and cardiac origin were all positive predictors of TH use and survival. On the other side, increasing age predicted a lower utilisation of TH: Odds Ratio (OR), 0.96 (95% CI, 0.94 to 0.97); as well as a lower survival: OR 0.96 (95% CI, 0.94 to 0.97). Female gender was also associated with a lower use of TH: OR 0.65 (95% CI, 0.43 to 0.97); and a poorer survival: OR 0.57 (95% CI, 0.36 to 0.92). After correcting for other prognostic factors, use of TH remained an independent predictor of improved survival with OR 1.91 (95% CI 1.18-3.06; P <0.001). Analysing subgroups divided after initial rhythm, these effects remained unchanged for patients with shockable rhythm, but not for patients with non-shockable rhythm where use of TH and female gender lost their predictive value.
Although TH was used in the majority of unconscious OHCA patients admitted to the ICU, actual use varied significantly between subgroups. Increasing age predicted both a decreased utilisation of TH as well as lower survival. Further, in patients with a shockable rhythm female gender predicted both a lower use of TH and poorer survival. Our results indicate an underutilisation of TH in some subgroups. Hence, more research on factors affecting TH use and the associated outcomes in subgroups of post-resuscitation patients is needed.</description><identifier>ISSN: 1364-8535</identifier><identifier>EISSN: 1466-609X</identifier><identifier>EISSN: 1364-8535</identifier><identifier>DOI: 10.1186/cc12826</identifier><identifier>PMID: 23880105</identifier><language>eng</language><publisher>England: BioMed Central Ltd</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Cardiac arrest ; Cardiac patients ; Care and treatment ; Female ; Health aspects ; Humans ; Hypothermia ; Hypothermia, Induced - methods ; Hypothermia, Induced - trends ; Intensive Care Units - trends ; Male ; Middle Aged ; Out-of-Hospital Cardiac Arrest - diagnosis ; Out-of-Hospital Cardiac Arrest - mortality ; Out-of-Hospital Cardiac Arrest - therapy ; Patient Admission - trends ; Predictive Value of Tests ; Prospective Studies ; Registries ; Retrospective Studies ; Risk factors ; Survival Rate - trends ; Treatment Outcome ; Unconscious (Psychology)</subject><ispartof>Critical care (London, England), 2013-07, Vol.17 (4), p.R147-R147, Article R147</ispartof><rights>COPYRIGHT 2013 BioMed Central Ltd.</rights><rights>Copyright © 2013 Lindner et al.; licensee BioMed Central Ltd. 2013 Lindner et al.; licensee BioMed Central Ltd.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c502t-47ee7c9d4858076c58d01e9df758ebc952ba53306a229ff64c509c1d21259e7a3</citedby><cites>FETCH-LOGICAL-c502t-47ee7c9d4858076c58d01e9df758ebc952ba53306a229ff64c509c1d21259e7a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4057368/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4057368/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23880105$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lindner, T W</creatorcontrib><creatorcontrib>Langørgen, J</creatorcontrib><creatorcontrib>Sunde, K</creatorcontrib><creatorcontrib>Larsen, A I</creatorcontrib><creatorcontrib>Kvaløy, J T</creatorcontrib><creatorcontrib>Heltne, J K</creatorcontrib><creatorcontrib>Draegni, T</creatorcontrib><creatorcontrib>Søreide, E</creatorcontrib><title>Factors predicting the use of therapeutic hypothermia and survival in unconscious out-of-hospital cardiac arrest patients admitted to the ICU</title><title>Critical care (London, England)</title><addtitle>Crit Care</addtitle><description>Therapeutic hypothermia (TH) after out-of-hospital cardiac arrest (OHCA) was adopted early in Norway. Since 2004 the general recommendation has been to cool all unconscious OHCA patients treated in the intensive care unit (ICU), but the decision to cool individual patients was left to the responsible physician. We assessed factors that were associated with use of TH and predicted survival.
We conducted a retrospective observational study of prospectively collected cardiac arrest and ICU registry data from 2004 to 2008 at three university hospitals.
A total of 715 unconscious patients older than 18 years of age, who suffered OHCA of both cardiac and non-cardiac causes, were included. With an overall TH use of 70%, the survival to discharge was 42%, with 90% of the survivors having a favourable cerebral outcome. Known positive prognostic factors such as witnessed arrest, bystander cardio pulmonary resuscitation (CPR), shockable rhythm and cardiac origin were all positive predictors of TH use and survival. On the other side, increasing age predicted a lower utilisation of TH: Odds Ratio (OR), 0.96 (95% CI, 0.94 to 0.97); as well as a lower survival: OR 0.96 (95% CI, 0.94 to 0.97). Female gender was also associated with a lower use of TH: OR 0.65 (95% CI, 0.43 to 0.97); and a poorer survival: OR 0.57 (95% CI, 0.36 to 0.92). After correcting for other prognostic factors, use of TH remained an independent predictor of improved survival with OR 1.91 (95% CI 1.18-3.06; P <0.001). Analysing subgroups divided after initial rhythm, these effects remained unchanged for patients with shockable rhythm, but not for patients with non-shockable rhythm where use of TH and female gender lost their predictive value.
Although TH was used in the majority of unconscious OHCA patients admitted to the ICU, actual use varied significantly between subgroups. Increasing age predicted both a decreased utilisation of TH as well as lower survival. Further, in patients with a shockable rhythm female gender predicted both a lower use of TH and poorer survival. Our results indicate an underutilisation of TH in some subgroups. Hence, more research on factors affecting TH use and the associated outcomes in subgroups of post-resuscitation patients is needed.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Cardiac arrest</subject><subject>Cardiac patients</subject><subject>Care and treatment</subject><subject>Female</subject><subject>Health aspects</subject><subject>Humans</subject><subject>Hypothermia</subject><subject>Hypothermia, Induced - methods</subject><subject>Hypothermia, Induced - trends</subject><subject>Intensive Care Units - trends</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Out-of-Hospital Cardiac Arrest - diagnosis</subject><subject>Out-of-Hospital Cardiac Arrest - mortality</subject><subject>Out-of-Hospital Cardiac Arrest - therapy</subject><subject>Patient Admission - trends</subject><subject>Predictive Value of Tests</subject><subject>Prospective Studies</subject><subject>Registries</subject><subject>Retrospective Studies</subject><subject>Risk factors</subject><subject>Survival Rate - trends</subject><subject>Treatment Outcome</subject><subject>Unconscious (Psychology)</subject><issn>1364-8535</issn><issn>1466-609X</issn><issn>1364-8535</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNptks2KFDEQxxtR3HUV30ACHvTSaz466fRFWAZXFxa8uOAt1CTVM5HuTpukB_YhfGfTzri4IDmkKvWrf6qKqqrXjF4yptUHaxnXXD2pzlmjVK1o9_1psYVqai2FPKtepPSDUtZqJZ5XZ1xoTRmV59Wva7A5xETmiM7b7KcdyXskS0IS-tWMMOOSvSX7-zms_uiBwORIWuLBH2AgfiLLZMOUrA9LImHJdejrfUizzyVsIToPlkCMmDKZIXucciLgRp8zOpLDny9vNncvq2c9DAlfne6L6u7607fNl_r26-ebzdVtbSXluW5axNZ2rtFS01ZZqR1l2Lm-lRq3tpN8C1IIqoDzru9VU9I6yxxnXHbYgrioPh5152U7orOlngiDmaMfId6bAN48jkx-b3bhYBoqW6F0EXh_Eojh51LaMqNPFocBJiwzMEw2ZdJSUV7Qt0d0BwMaP_WhKNoVN1dSNG1bWlipy_9Q5TgcfZkt9r68P0p4d0ywMaQUsX-onlGz7oQ57UQh3_zb7AP3dwnEb-yds8w</recordid><startdate>20130723</startdate><enddate>20130723</enddate><creator>Lindner, T W</creator><creator>Langørgen, J</creator><creator>Sunde, K</creator><creator>Larsen, A I</creator><creator>Kvaløy, J T</creator><creator>Heltne, J K</creator><creator>Draegni, T</creator><creator>Søreide, E</creator><general>BioMed Central Ltd</general><general>BioMed Central</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20130723</creationdate><title>Factors predicting the use of therapeutic hypothermia and survival in unconscious out-of-hospital cardiac arrest patients admitted to the ICU</title><author>Lindner, T W ; Langørgen, J ; Sunde, K ; Larsen, A I ; Kvaløy, J T ; Heltne, J K ; Draegni, T ; Søreide, E</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c502t-47ee7c9d4858076c58d01e9df758ebc952ba53306a229ff64c509c1d21259e7a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Cardiac arrest</topic><topic>Cardiac patients</topic><topic>Care and treatment</topic><topic>Female</topic><topic>Health aspects</topic><topic>Humans</topic><topic>Hypothermia</topic><topic>Hypothermia, Induced - methods</topic><topic>Hypothermia, Induced - trends</topic><topic>Intensive Care Units - trends</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Out-of-Hospital Cardiac Arrest - diagnosis</topic><topic>Out-of-Hospital Cardiac Arrest - mortality</topic><topic>Out-of-Hospital Cardiac Arrest - therapy</topic><topic>Patient Admission - trends</topic><topic>Predictive Value of Tests</topic><topic>Prospective Studies</topic><topic>Registries</topic><topic>Retrospective Studies</topic><topic>Risk factors</topic><topic>Survival Rate - trends</topic><topic>Treatment Outcome</topic><topic>Unconscious (Psychology)</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lindner, T W</creatorcontrib><creatorcontrib>Langørgen, J</creatorcontrib><creatorcontrib>Sunde, K</creatorcontrib><creatorcontrib>Larsen, A I</creatorcontrib><creatorcontrib>Kvaløy, J T</creatorcontrib><creatorcontrib>Heltne, J K</creatorcontrib><creatorcontrib>Draegni, T</creatorcontrib><creatorcontrib>Søreide, E</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Critical care (London, England)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lindner, T W</au><au>Langørgen, J</au><au>Sunde, K</au><au>Larsen, A I</au><au>Kvaløy, J T</au><au>Heltne, J K</au><au>Draegni, T</au><au>Søreide, E</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Factors predicting the use of therapeutic hypothermia and survival in unconscious out-of-hospital cardiac arrest patients admitted to the ICU</atitle><jtitle>Critical care (London, England)</jtitle><addtitle>Crit Care</addtitle><date>2013-07-23</date><risdate>2013</risdate><volume>17</volume><issue>4</issue><spage>R147</spage><epage>R147</epage><pages>R147-R147</pages><artnum>R147</artnum><issn>1364-8535</issn><eissn>1466-609X</eissn><eissn>1364-8535</eissn><abstract>Therapeutic hypothermia (TH) after out-of-hospital cardiac arrest (OHCA) was adopted early in Norway. Since 2004 the general recommendation has been to cool all unconscious OHCA patients treated in the intensive care unit (ICU), but the decision to cool individual patients was left to the responsible physician. We assessed factors that were associated with use of TH and predicted survival.
We conducted a retrospective observational study of prospectively collected cardiac arrest and ICU registry data from 2004 to 2008 at three university hospitals.
A total of 715 unconscious patients older than 18 years of age, who suffered OHCA of both cardiac and non-cardiac causes, were included. With an overall TH use of 70%, the survival to discharge was 42%, with 90% of the survivors having a favourable cerebral outcome. Known positive prognostic factors such as witnessed arrest, bystander cardio pulmonary resuscitation (CPR), shockable rhythm and cardiac origin were all positive predictors of TH use and survival. On the other side, increasing age predicted a lower utilisation of TH: Odds Ratio (OR), 0.96 (95% CI, 0.94 to 0.97); as well as a lower survival: OR 0.96 (95% CI, 0.94 to 0.97). Female gender was also associated with a lower use of TH: OR 0.65 (95% CI, 0.43 to 0.97); and a poorer survival: OR 0.57 (95% CI, 0.36 to 0.92). After correcting for other prognostic factors, use of TH remained an independent predictor of improved survival with OR 1.91 (95% CI 1.18-3.06; P <0.001). Analysing subgroups divided after initial rhythm, these effects remained unchanged for patients with shockable rhythm, but not for patients with non-shockable rhythm where use of TH and female gender lost their predictive value.
Although TH was used in the majority of unconscious OHCA patients admitted to the ICU, actual use varied significantly between subgroups. Increasing age predicted both a decreased utilisation of TH as well as lower survival. Further, in patients with a shockable rhythm female gender predicted both a lower use of TH and poorer survival. Our results indicate an underutilisation of TH in some subgroups. Hence, more research on factors affecting TH use and the associated outcomes in subgroups of post-resuscitation patients is needed.</abstract><cop>England</cop><pub>BioMed Central Ltd</pub><pmid>23880105</pmid><doi>10.1186/cc12826</doi><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1364-8535 |
| ispartof | Critical care (London, England), 2013-07, Vol.17 (4), p.R147-R147, Article R147 |
| issn | 1364-8535 1466-609X 1364-8535 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_4057368 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Springer Nature OA Free Journals; EZB-FREE-00999 freely available EZB journals; PubMed Central; Alma/SFX Local Collection; SpringerLink Journals - AutoHoldings |
| subjects | Adult Aged Aged, 80 and over Cardiac arrest Cardiac patients Care and treatment Female Health aspects Humans Hypothermia Hypothermia, Induced - methods Hypothermia, Induced - trends Intensive Care Units - trends Male Middle Aged Out-of-Hospital Cardiac Arrest - diagnosis Out-of-Hospital Cardiac Arrest - mortality Out-of-Hospital Cardiac Arrest - therapy Patient Admission - trends Predictive Value of Tests Prospective Studies Registries Retrospective Studies Risk factors Survival Rate - trends Treatment Outcome Unconscious (Psychology) |
| title | Factors predicting the use of therapeutic hypothermia and survival in unconscious out-of-hospital cardiac arrest patients admitted to the ICU |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-27T05%3A41%3A29IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Factors%20predicting%20the%20use%20of%20therapeutic%20hypothermia%20and%20survival%20in%20unconscious%20out-of-hospital%20cardiac%20arrest%20patients%20admitted%20to%20the%20ICU&rft.jtitle=Critical%20care%20(London,%20England)&rft.au=Lindner,%20T%20W&rft.date=2013-07-23&rft.volume=17&rft.issue=4&rft.spage=R147&rft.epage=R147&rft.pages=R147-R147&rft.artnum=R147&rft.issn=1364-8535&rft.eissn=1466-609X&rft_id=info:doi/10.1186/cc12826&rft_dat=%3Cgale_pubme%3EA534778072%3C/gale_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1548635602&rft_id=info:pmid/23880105&rft_galeid=A534778072&rfr_iscdi=true |