Factors Associated with Delayed Cooling in Cardiac Arrest Patients

Area of Science:

• Cardiology
• Neurology
• Emergency Medicine

Background:

• Therapeutic hypothermia improves neurologic outcomes in cardiac arrest survivors.
• Factors delaying target temperature achievement in therapeutic hypothermia are not well understood.
• A timely "door-to-cool" (DTC) goal is crucial for effective hypothermia therapy.

Purpose of the Study:

• To identify factors associated with achieving the institutional "door-to-cool" (DTC) performance goal of ≤4 hours for medical cardiac arrest patients.
• To determine if achieving the DTC goal is associated with the timing of neuromuscular blockade (NMB), survival, or functional outcomes.

Main Methods:

• Retrospective cohort study utilizing a medical cardiac arrest quality improvement database (November 2007 - August 2012).
• Data collected included patient demographics, arrest characteristics, cooling techniques, emergent imaging, and outcomes.
• Logistic regression analysis was used to assess factors associated with DTC goal achievement and patient outcomes.

Main Results:

• Of 327 patients, 44% survived to discharge with 41% achieving good functional outcome (Cerebral Performance Category 1-2).
• Induction with cold IV fluids (OR 0.50) and NMB administration within 2 hours of ED arrival (OR 2.95) were associated with achieving the DTC goal.
• Achieving the DTC goal within 4 hours was not significantly associated with good functional outcome (OR 0.59).

Conclusions:

• Initiation of cold intravenous fluids and early NMB administration were associated with improved DTC goal performance.
• Despite factors influencing timely cooling, achieving the DTC goal was not linked to improved functional outcomes in this single-center cohort.