Early therapeutic hypothermia in sudden cardiac death and following return of spontaneous circulation

Introduction

The aim of this study is to assess the role of therapeutic hypothermia on neurological outcome in patients who experienced sudden cardiac death (SCA) with ensuing return of spontaneous circulation.

Methods

Thirty adult patients, aged between 18 and 85 years, referred to our ICU after SCA due to cardiac disease with following return of spontaneous circulation were randomly allocated to the following treatment groups: patients in group 1 were treated immediately after admission with therapeutic hypothermia plus standard treatment, patients in group 2 received only standard treatment. All patients at entry presented with GCS 3. Neurological outcome was assessed on discharge and after 6 months, by means of the GOS scale (0 = dead, 1 = vegetative, 2 = severely disabled, 3 = moderately disabled, 4 = good recovery). We consider scores 0–1 as unfavourable outcome, scores from 2 to 4 as favourable outcome. To compare the two groups we used the Mann–Whitney U test of for continuous variables, the chi-square test for qualitative variables.

Results

Patients in group 1 (15 patients) and in group 2 (15 patients) were statistically comparable for sex (P = 0.16) and age (P = 0.77) and presentation ECG rhythm (P = 0.63). Median GOS values at discharge from the ICU were 2 (interquartile range 25–75% (IR) 1–3) in group 1 and 1 (IR 0–1) in group 2 (P = 0.06). Median GOS values at 6 months were 3 (IR 1–4) in group 1 and 1(IR 1–2) in group 2 (P = 0.09). The patients who improved their GOS values were 9/15 (60%) in group 1 and 2/15 (13.3%) in group 2 (P < 0.003).

Conclusion

Our study demonstrated that early treatment with therapeutic hypothermia in the patient who had SCA improves neurological outcome.