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Mild induced hypothermia and survival after out-of-hospital cardiac arrest in a Swedish urban area

Martinell, Louise; Herlitz, Johan; Karlsson, Thomas; Nielsen, Niklas LU and Rylander, Christian (2017) In American Journal of Emergency Medicine 35(11). p.1595-1600
Abstract

Background: Mild induced hypothermia (MIH) was introduced for post cardiac arrest care in Sweden in 2003, based on two clinical trials. This retrospective study evaluated its association with 30-day survival after out-of-hospital cardiac arrest (OHCA) in a Swedish community from 2003 to 2015. Methods: Out of 3680 patients with OHCA, 1100 were hospitalized after return of spontaneous circulation and 871 patients who remained unconscious were included in the analysis. Prehospital data were extracted from the Swedish Registry of Cardiopulmonary Resuscitation and in-hospital data were extracted from clinical records. Propensity score analysis on complete data sets and multivariable logistic regression with multiple imputations to compensate... (More)

Background: Mild induced hypothermia (MIH) was introduced for post cardiac arrest care in Sweden in 2003, based on two clinical trials. This retrospective study evaluated its association with 30-day survival after out-of-hospital cardiac arrest (OHCA) in a Swedish community from 2003 to 2015. Methods: Out of 3680 patients with OHCA, 1100 were hospitalized after return of spontaneous circulation and 871 patients who remained unconscious were included in the analysis. Prehospital data were extracted from the Swedish Registry of Cardiopulmonary Resuscitation and in-hospital data were extracted from clinical records. Propensity score analysis on complete data sets and multivariable logistic regression with multiple imputations to compensate for missing data were performed. Results: Unadjusted 30-day survival was 23.5%; 37% in 386/871 (44%) MIH treated and 13% in 485/871 (56%) non-MIH treated patients. Unadjusted odds ratio (OR) for 30-day survival in patients treated with MIH compared to non-MIH treated patients was 3.79 (95% CI 2.71-5.29; p. <. 0.0001). Using stratified propensity score analysis and in addition adjusting for in-hospital factors, 30-day survival was not significantly different in patients treated with MIH compared to non-MIH treated patients; OR 1.33 (95% CI 0.83-2.15; p = 0.24). Using multiple imputations to handle missing data yielded a similar adjusted OR of 1.40 (95% CI 0.88-2.22; p = 0.15). Good neurologic outcome at hospital discharge was seen in 82% of patients discharged alive. Conclusion: Treatment with MIH was not significantly associated with increased 30-day survival in patients remaining unconscious after OHCA when adjusting for potential confounders.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Mild induced hypothermia, Out-of-hospital cardiac arrest, Survival
in
American Journal of Emergency Medicine
volume
35
issue
11
pages
1595 - 1600
publisher
Elsevier
external identifiers
  • scopus:85018416718
  • wos:000415201700002
ISSN
0735-6757
DOI
10.1016/j.ajem.2017.04.071
language
English
LU publication?
yes
id
a8625ed7-6be6-422a-b71d-0e1e0105d411
date added to LUP
2017-05-19 09:15:20
date last changed
2018-01-16 13:26:32
@article{a8625ed7-6be6-422a-b71d-0e1e0105d411,
  abstract     = {<p>Background: Mild induced hypothermia (MIH) was introduced for post cardiac arrest care in Sweden in 2003, based on two clinical trials. This retrospective study evaluated its association with 30-day survival after out-of-hospital cardiac arrest (OHCA) in a Swedish community from 2003 to 2015. Methods: Out of 3680 patients with OHCA, 1100 were hospitalized after return of spontaneous circulation and 871 patients who remained unconscious were included in the analysis. Prehospital data were extracted from the Swedish Registry of Cardiopulmonary Resuscitation and in-hospital data were extracted from clinical records. Propensity score analysis on complete data sets and multivariable logistic regression with multiple imputations to compensate for missing data were performed. Results: Unadjusted 30-day survival was 23.5%; 37% in 386/871 (44%) MIH treated and 13% in 485/871 (56%) non-MIH treated patients. Unadjusted odds ratio (OR) for 30-day survival in patients treated with MIH compared to non-MIH treated patients was 3.79 (95% CI 2.71-5.29; p. &lt;. 0.0001). Using stratified propensity score analysis and in addition adjusting for in-hospital factors, 30-day survival was not significantly different in patients treated with MIH compared to non-MIH treated patients; OR 1.33 (95% CI 0.83-2.15; p = 0.24). Using multiple imputations to handle missing data yielded a similar adjusted OR of 1.40 (95% CI 0.88-2.22; p = 0.15). Good neurologic outcome at hospital discharge was seen in 82% of patients discharged alive. Conclusion: Treatment with MIH was not significantly associated with increased 30-day survival in patients remaining unconscious after OHCA when adjusting for potential confounders.</p>},
  author       = {Martinell, Louise and Herlitz, Johan and Karlsson, Thomas and Nielsen, Niklas and Rylander, Christian},
  issn         = {0735-6757},
  keyword      = {Mild induced hypothermia,Out-of-hospital cardiac arrest,Survival},
  language     = {eng},
  month        = {03},
  number       = {11},
  pages        = {1595--1600},
  publisher    = {Elsevier},
  series       = {American Journal of Emergency Medicine},
  title        = {Mild induced hypothermia and survival after out-of-hospital cardiac arrest in a Swedish urban area},
  url          = {http://dx.doi.org/10.1016/j.ajem.2017.04.071},
  volume       = {35},
  year         = {2017},
}