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Purpose: This is a retrospective comparative study about neurological outcomes of comatose patients after out of hospital cardiac arrest (OHCA) due to ventricular fibrillation (VF) who presented before and after implementation of comprehensive post-cardiac arrest care including therapeutic hypothermia (TH) and immediate coronary angiography (CAG) in a community hospital.
Subjects and Method: We evaluated 26 comatose survivors with reactive pupils or spontaneous breathing (Before April 2008 when we have started to implement the TH and immediate CAG, we defined Pre-TH patients and assigned 14 patients.Thereafter, we defined Post-TH patients and assigned 12 patients) among 52 consecutive OHCA due to VF cases from December/1/2003 to May/31/2011. In Post-TH patients, an immediate CAG was always performed to decide the indication of percutaneous coronary interventions (PCI) followed by active surface cooling to achieve a rectal temperature of 34°C. The primary outcomes were length of stay, mortality, the neurologic outcome after 1 month, the rates of hospital procedures (CAG, PCI, etc) and complications. The secondary outcomes were the comparison of the frequency of acute coronary syndrome, interventions and complications between the favorable (CPC: Pittsburgh cerebral performance category 1-2) and non-favorable neurologic outcomes (CPC 3-5). All data were compared using Fisher’s exact test or Student’s t-test.
Results: The rate of favorable neurologic outcome significantly improved in the Post TH patients (p<0.05), the mortality rate was not significantly different (p=0.13). The rates of CAG performance and intra-aortic balloon pumping (IABP) use were higher in the Post-TH patients (p<0.05). The rate of pulmonary edema alone was lower in the Post-TH patients (p<0.05) among complications. As for neurological outcomes, the frequency of TH and immediate CAG was higher (p<0.05) and that of pulmonary edema was lower (p<0.01) in the favorable outcome.
Conclusions: The comprehensive post-cardiac arrest care including TH, CAG and IABP could be associated with a significant improvement in neurologic outcomes and reduction of the complication of pulmonary edema in comatose survivors whose initial rhythm was VF.
