Therapeutic hypothermia has been credited with saving the lives of a growing number of patients with cardiac arrest; © panthermedia.net/
The brain-preserving cooling treatment known as therapeutic hypothermia is rarely being used in patients who suffer cardiac arrest while in the hospital, despite its proven potential to improve survival and neurological function.
Researchers from the Perelman School of Medicine at the University of Pennsylvania suggest that scarce data about in-hospital cardiac arrest patients and guidelines that only call for health care providers to consider use of therapeutic hypothermia, rather than explicitly recommending it, may explain the study's results. The Penn team found that 98 percent of over 67,000 patients who went into cardiac arrest in the hospital received only conventional post-resuscitation care - leaving just 2 percent who received therapeutic hypothermia, which has been credited with saving the lives of a growing number of patients who arrest outside hospitals.
"We know it is being used in patients who went into cardiac arrest in their homes, at work, or anywhere else outside of a hospital, but little was known about how often it is used in patients who arrest in the hospital," said Mark E. Mikkelsen, assistant professor in the division of Pulmonology, Critical Care and Allergy at Penn Medicine. "We found that even though most hospitals have the capability to treat these patients with therapeutic hypothermia, it is not being used. And even when it was used, in nearly half the cases, the correct target temperature was not being achieved. Several factors could explain this: there is little data, which is often conflicting, to support its use for patients in the hospital, and we have national guidelines that only have clinicians considering its use, which may lead to hesitation and lack of institutional protocol."
Cooling the body down to about 89.6 degrees after cardiac arrest protects it against neurological damage initiated by the lack of blood flow and oxygenation, several studies of out-of-hospital cardiac arrest patients have shown. It has also been shown to improve survival - a welcome development, since cardiac arrest survival statistics remain grim, with less than 10 percent of patients surviving in most cities across the U.S.
National recommendations established in 2005 call for out-of-hospital cardiac arrest patients to be treated with hypothermia when they remain comatose after resuscitation. In-hospital recommendations, however, are less direct. The International Liaison Committee on Resuscitation guidelines recommend providers to "consider its use," while the American Heart Association recommends that therapeutic hypothermia "may be considered" for a patient who goes into cardiac arrest caused by non-shockable rhythms.
"I believe there is potential for therapeutic hypothermia to benefit this population, but traction can only be made after clinical trials investigating safety and effectiveness are initiated-which are certainly warranted. Results of those studies could strengthen the case for stronger recommendations and increase use," said Mikkelsen.
MEDICA.de; Source: University of Pennsylvania School of Medicine