Tomasz Darocha1, Paweł Podsiadło2, Maciej Polak3, Hubert Hymczak4, Łukasz Krzych5, Janusz Skalski6, Anna Witt-Majchrzak7, Ewelina Nowak2, Krzysztof Toczek8, Szymon Waligórski9, Aleksandra Kret10, Dominik Drobiński11, Barbara Barteczko-Grajek12, Wojciech Dąbrowski13, Romuald Lango14, Beata Horeczy15, Tomasz Romaniuk16, Tomasz Czarnik17, Mateusz Puślecki18, Krzysztof Jarmoszewicz19, Tomasz Sanak20, Robert Gałązkowski21, Rafał Drwiła4, Sylweriusz Kosiński22. 1. Department of Anaesthesiology and Intensive Care, Medical University of Silesia, Katowice, Poland. Electronic address: tomekdarocha@wp.pl. 2. Emergency Medicine Department, Jan Kochanowski University, Kielce, Poland. 3. Department of Epidemiology and Population Studies, Jagiellonian University Medical College, Kraków, Poland. 4. Department of Anaesthesiology and Intensive Care, John Paul II Hospital, Jagiellonian University Medical College, Kraków, Poland. 5. Department of Anaesthesiology and Intensive Care, Medical University of Silesia, Katowice, Poland. 6. Paediatric Cardiac Surgery Department, University Children's Hospital, Jagiellonian University, Medical College, Kraków, Poland. 7. Department of Cardiac Surgery Provincial Specialist Hospital, Olsztyn, Poland. 8. Department of Cardiac Surgery, 4th Military Hospital, Wrocław, Poland. 9. Department of Cardiosurgery, Pomeranian Medical University in Szczecin, Szczecin, Poland. 10. Department of Anaesthesia and Intensive Care, Center for Cardiovascular Research and Development, American Heart of Poland, Bielsko Biała, Poland. 11. Cardiosurgery Clinic and Department of Cardiac Anaesthesia, the Central Clinical Hospital of the Ministry of the Interior and Administration in Warsaw, Warsaw, Poland. 12. Department and Clinic of Anaesthesiology and Intensive Care, Wroclaw Medical University, Wrocław, Poland. 13. Department of Anaesthesiology and Intensive Care, Medical University of Lublin, Lublin, Poland. 14. Department of Cardioanaesthesiology, Medical University of Gdansk, Gdansk, Poland. 15. Anaesthesiology and Intensive Care Clinic with the Centre for Acute Poisoning, St. Jadwiga's Provincial Clinical Hospital, Rzeszów, Poland. 16. Department of Cardiac Surgery, Regional Specialist Hospital, Grudziądz, Poland. 17. Department of Anaesthesiology and Intensive Care and Regional ECMO Centre, Opole University Hospital, Opole, Poland. 18. Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznan, Poland. 19. Department of Cardiac Surgery, Ceynowa Specialist Hospital, Wejherowo, Poland. 20. Department of Disaster Medicine and Emergency Care, Jagiellonian University Medical College, Krakow, Poland. 21. Department of Emergency Medical Services, Medical University of Warsaw, Warsaw, Poland. 22. Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland.
Abstract
OBJECTIVE: Extracorporeal rewarming is the treatment of choice for patients who had hypothermic cardiac arrest, allowing for best neurologic outcome. The authors' goal was to identify factors associated with survival in nonasphyxia-related hypothermic cardiac arrest patients undergoing extracorporeal rewarming. DESIGN: All 38 cardiac surgery departments in Poland were encouraged to report consecutive hypothermic cardiac arrest patients treated with extracorporeal life support. All variables collected were analyzed in order to compare survivor and nonsurvivor groups. The parameters available at the initiation of extracorporeal rewarming were considered as potential predictors of survival in a logistic regression model. The primary outcome was survival to discharge from the intensive care unit. The secondary outcome was neurologic status. SETTING: Multicenter retrospective study. PARTICIPANTS: Ninety-eight cases in the final analysis. INTERVENTIONS: All patients in nonasphyxia-related hypothermic cardiac arrest rewarmed with extracorporeal life support. MEASUREMENTS AND MAIN RESULTS: The survival rate was 53.1%, and 94.2% of survivors had favorable neurologic outcome. The lowest reported core temperature with cerebral performance category scale 1 was 11.8°C. A univariate analysis identified 3 variables associated with survival, namely: age, initial arterial pH, and lactate concentration. In a multivariate analysis, 2 independent predictors of survival were age (0.957; 95% confidence interval [CI] 0.924-0.991) and lactates (0.871; 95% CI 0.789-0.961). The area under the receiver operating characteristics curve for this fitted model was 0.71; 95% CI 0.602-0.817. CONCLUSIONS: Favorable survival with good neurologic outcome in nonasphyxiated hypothermic patients treated with extracorporeal life support was reported. Age and initial lactate level are independently associated with survival.
OBJECTIVE: Extracorporeal rewarming is the treatment of choice for patients who had hypothermic cardiac arrest, allowing for best neurologic outcome. The authors' goal was to identify factors associated with survival in nonasphyxia-related hypothermic cardiac arrestpatients undergoing extracorporeal rewarming. DESIGN: All 38 cardiac surgery departments in Poland were encouraged to report consecutive hypothermic cardiac arrestpatients treated with extracorporeal life support. All variables collected were analyzed in order to compare survivor and nonsurvivor groups. The parameters available at the initiation of extracorporeal rewarming were considered as potential predictors of survival in a logistic regression model. The primary outcome was survival to discharge from the intensive care unit. The secondary outcome was neurologic status. SETTING: Multicenter retrospective study. PARTICIPANTS: Ninety-eight cases in the final analysis. INTERVENTIONS: All patients in nonasphyxia-related hypothermic cardiac arrest rewarmed with extracorporeal life support. MEASUREMENTS AND MAIN RESULTS: The survival rate was 53.1%, and 94.2% of survivors had favorable neurologic outcome. The lowest reported core temperature with cerebral performance category scale 1 was 11.8°C. A univariate analysis identified 3 variables associated with survival, namely: age, initial arterial pH, and lactate concentration. In a multivariate analysis, 2 independent predictors of survival were age (0.957; 95% confidence interval [CI] 0.924-0.991) and lactates (0.871; 95% CI 0.789-0.961). The area under the receiver operating characteristics curve for this fitted model was 0.71; 95% CI 0.602-0.817. CONCLUSIONS: Favorable survival with good neurologic outcome in nonasphyxiated hypothermicpatients treated with extracorporeal life support was reported. Age and initial lactate level are independently associated with survival.
Authors: Peter Paal; Mathieu Pasquier; Tomasz Darocha; Raimund Lechner; Sylweriusz Kosinski; Bernd Wallner; Ken Zafren; Hermann Brugger Journal: Int J Environ Res Public Health Date: 2022-01-03 Impact factor: 3.390