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Results of using a therapeutic hypothermia protocol after cardiac arrest: design and application by an emergency medical service and a hospital emergency department

Barreña Oceja I, Gil Martín FJ, García De Vicuña Meléndez A, Rodríguez Delgadillo MA, Gutiérrez Herrador G, Vázquez Naveira MP

Servicio de Urgencias. Hospital de Cruces. Barakaldo. Bizkaia, Spain. Emergentziak. Osakidetza. Servicio de CirugĂ­a Cardiovascular. Hospital de Cruces. Barakaldo. Bizkaia, Spain.

Objective: To describe a multidisciplinary team’s use of therapeutic hypothermia to
improve neurologic outcome after cardiac arrest.
Methods: Retrospective, descriptive study of consecutive patients treated over a period
of 16 months in the area served by the emergency department of Hospital de Cruces in
Barakaldo, Bizkaia, Spain, and the emergency response services in the hospital’s referral
area. Clinical and sociodemographic data were analyzed for patients in whom
spontaneous circulation returned after out-of-hospital cardiac arrest.
Results: We included 34 patients: 10 (29.4%) were treated with hypothermia, in 7
(20.5%) hypothermia was induced but then interrupted, and in 17 (50%) use of
hypothermia was ruled out. In 4 patients in the last group, heart rhythm recovered in
situ and consciousness returned on early pre-hospital defibrillation. Survival with good
neurologic recovery was achieved in 60% of the hypothermia-treated patients and in
15% of those who were excluded from hypothermia (P<.05). However, the patients who
received hypothermia were younger (P<.001) and did not have a relevant medical
history (P<.05).
Conclusions: The use of therapeutic hypothermia requires effective coordination
between emergency services (staff of pre-hospital and hospital services and critical care
units) in order to achieve optimal results. With strategic coordination, it is possible to use
this approach in nearly 30% of pre-hospital cardiopulmonary resuscitations.

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