ACS network-based implementation of therapeutic hypothermia for the treatment of comatose out-of-hospital cardiac arrest survivors improves clinical outcomes: the first European experience

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dc.contributor.author Koziński, Marek
dc.contributor.author Pstrągowski, Krzysztof
dc.contributor.author Kubica, Julia Maria
dc.contributor.author Fabiszak, Tomasz
dc.contributor.author Kasprzak, Michał
dc.contributor.author Kuffel, Błażej
dc.contributor.author Paciorek, Przemysław
dc.contributor.author Navarese, Eliano Pio
dc.contributor.author Grześk, Grzegorz
dc.contributor.author Kubica, Jacek
dc.date.accessioned 2013-04-17T12:12:35Z
dc.date.available 2013-04-17T12:12:35Z
dc.date.issued 2013-04-17
dc.identifier.citation Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, vol. 21, 2013,
dc.identifier.issn 1757-7241
dc.identifier.uri http://repozytorium.umk.pl/handle/item/490
dc.description.abstract Background: There is a paucity of data regarding clinical outcomes associated with the integration of a mild therapeutic hypothermia (MTH) protocol into a regional network dedicated to treatment of patients with acute coronary syndromes (ACS). Additionally, a recent report suggests that the neurological benefits of MTH therapy in interventionally managed ACS patients resuscitated from out-of-hospital cardiac arrest (OHCA) may be potentially offset by the catastrophic occurrence of stent thrombosis. The goal of this study was to share our experience with the implementation of an MTH program using a previously established ACS network in consecutive comatose OHCA survivors undergoing interventional management due to an initial diagnosis of ACS and to assess the clinical effectiveness and safety of MTH. Methods: We conducted a retrospective historically controlled single centre study. Hospital survival with a favourable neurological outcome (Cerebral Performance Category of 1 or 2) and all-cause in-hospital mortality were the primary and secondary efficacy end points, respectively. Occurrence of definite stent thrombosis was the primary safety end point while the development of pneumonia, presence of positive blood cultures, occurrence of probable stent thrombosis, any bleeding complications, need for red blood cell transfusion and presence of rhythm and conductions disorders during hospitalisation constituted secondary safety end points. Results: Comatose OHCA survivors (n = 32) were referred to our Department based on ECG recording transmissions and/ or phone consultations or admitted from the Emergency Department. Compared with controls (n = 33), they were significantly more likely to be discharged from hospital with a favourable neurological outcome (59 vs. 27%; p < 0.05; number needed to treat [NNT] = 3.11) and experienced lower all-cause in-hospital mortality (13 vs. 55%; p < 0.05; NNT = 2.38). Rates of all safety end points were similar in patients treated with and without MTH. Conclusions: Our study indicates that a regional system of care for OHCA survivors may be successfully implemented based on an ACS network, leading to an improvement in neurological status and to a reduction of in-hospitalmortality in patients treated with MTH, without any excess of complications. However, our findings should be verified in large, prospective trials.
dc.language.iso eng
dc.rights info:eu-repo/semantics/openAccess
dc.subject Hypothermia
dc.subject Cardiac arrest
dc.subject Regional system of care
dc.subject stent thrombosis
dc.title ACS network-based implementation of therapeutic hypothermia for the treatment of comatose out-of-hospital cardiac arrest survivors improves clinical outcomes: the first European experience
dc.type info:eu-repo/semantics/article

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