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Published on: November 21, 2017
Out-of-hospital cardiac arrest complicated by hyperthermia
1London Ambulance Service NHS Trust, 220 Waterloo Road, London SE1 8SD, United Kingdom.
Insights
Adults experiencing out-of-hospital cardiac arrest with hyperthermia have poor outcomes, with infection being the most common cause. Therapeutic hypothermia was infrequently applied, indicating a need for improved management strategies for these critical patients.
Area of Science:
- Emergency Medicine
- Cardiology
- Critical Care
Background:
- Out-of-hospital cardiac arrest (OHCA) complicated by hyperthermia is a critical medical emergency.
- Existing research on this patient subset is limited to small case series.
- This study addresses the need for comprehensive data on OHCA with hyperthermia.
Purpose of the Study:
- To establish the epidemiology of adult OHCA with hyperthermia.
- To analyze clinical management and outcomes in these patients.
- To improve knowledge and guide therapeutic interventions.
Main Methods:
- Retrospective analysis of 253 adult cases of OHCA with hyperthermia.
- Data abstracted from the London Ambulance Service NHS Trust cardiac arrest database (2018-2019).
- Analysis included patient demographics, presumed aetiology, and management interventions.
Main Results:
- The median age was 72 years, with 53.4% female patients.
- Thirty-day mortality was high at 94.5%.
- Infection was the presumed aetiology in 62.8% of cases; cooling was infrequently applied.
Conclusions:
- This study represents a comprehensive analysis of OHCA with hyperthermia.
- Infection is the most common cause, differing from drug-related or heat illness aetiologies.
- Infrequent and inconsistent application of cooling methods highlights a gap in current management.
Background:
The aims of this study were to establish epidemiology, clinical management and outcomes in cases of adult out-of-hospital cardiac arrest complicated by hyperthermia attended by the London Ambulance Service NHS Trust between January 2018 and December 2019. Where evidence is available in relation to this sub-set of cardiac arrest patients it is generally limited to small case series and we therefore we sought to improve knowledge and target therapeutic interventions.
Methods And Results:
Retrospective analysis of 253 cases was undertaken following abstraction from an established cardiac arrest database. Age ranged from 18-99 years with a median of 72 years (IQR 28) and 53.4% (n = 135) of patients were female. Overall thirty-day mortality was 94.5% (n = 239), with 48.2% (n = 122) of patients recognised life extinct in the out-of-hospital phase following termination of resuscitation. No significant differences in clinical characteristics stratified according to temperature group were identified. The presumed aetiology was infective in 62.8% (n = 159) of patients, and due to drug ingestion or heat illness in 7.5% (n = 19) and 2% (n = 5) respectively. In the remaining cases (27.7%, n = 70) it was not possible to determine the likely cause of the arrest.
Conclusions:
Previous research relating to cardiac arrest complicated by hyperthermia is limited to case reports and small case series, suggesting that the current study represents the most comprehensive analysis of this sub-group of out-of-hospital cardiac arrest patients currently available. Most cases were associated with evidence of infection compared with drug related aetiologies and heat illness. Where indicated, cooling was applied infrequently using inconsistent methods.
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