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Therapeutic hypothermia after out-of-hospital cardiac arrest in Finnish intensive care units: the FINNRESUSCI study

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Abstract

Purpose

We aimed to evaluate post-resuscitation care, implementation of therapeutic hypothermia (TH) and outcomes of intensive care unit (ICU)-treated out-of-hospital cardiac arrest (OHCA) patients in Finland.

Methods

We included all adult OHCA patients admitted to 21 ICUs in Finland from March 1, 2010 to February 28, 2011 in this prospective observational study. Patients were followed (mortality and neurological outcome evaluated by Cerebral Performance Categories, CPC) within 1 year after cardiac arrest.

Results

This study included 548 patients treated after OHCA. Of those, 311 patients (56.8 %) had a shockable initial rhythm (incidence of 7.4/100,000/year) and 237 patients (43.2 %) had a non-shockable rhythm (incidence of 5.6/100,000/year). At ICU admission, 504 (92 %) patients were unconscious. TH was given to 241/281 (85.8 %) unconscious patients resuscitated from shockable rhythms, with unfavourable 1-year neurological outcome (CPC 3–4–5) in 42.0 % with TH versus 77.5 % without TH (p < 0.001). TH was given to 70/223 (31.4 %) unconscious patients resuscitated from non-shockable rhythms, with 1-year CPC of 3–4–5 in 80.6 % (54/70) with TH versus 84.0 % (126/153) without TH (p = 0.56). This lack of difference remained after adjustment for propensity to receive TH in patients with non-shockable rhythms.

Conclusions

One-year unfavourable neurological outcome of patients with shockable rhythms after TH was lower than in previous randomized controlled trials. However, our results do not support use of TH in patients with non-shockable rhythms.

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Acknowledgments

The authors acknowledge all the participants of the FINNRESUSCI study, especially the study doctors and nurses in the participating ICUs. We also thank Tieto Ltd, Helsinki for processing the database of the Finnish Intensive Care Consortium.

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Correspondence to Jukka Vaahersalo.

Additional information

Preliminary results of this study were presented at the ESICM Annual Congress, Berlin, Germany 2011.

The members of the FINNRESUSCI Study Group are presented in the “Appendix”.

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Appendix

Appendix

The FINNRESUSCI Study Group: Participating hospitals, investigators (Inv.) and study nurses (SN.) in the FINNRESUSCI study.

Satakunta Central Hospital, Dr. Vesa Lund (Inv.), Päivi Tuominen, Satu Johansson, Pauliina Perkola, Elina Kumpulainen (SN.); East Savo Central Hospital, Dr. Markku Suvela (Inv.), Sari Hirvonen, Sirpa Kauppinen (SN.); Central Finland Central Hospital, Dr. Raili Laru-Sompa (Inv.), Mikko Reilama (SN.); South Savo Central Hospital, Dr. Heikki Laine (Inv.), Pekka Kettunen, Iina Smolander (SN.); North Carelia Central Hospital, Dr. Matti Reinikainen (Inv.), Tero Surakka (SN.); Seinäjoki Central Hospital, Dr. Kari Saarinen (Inv.), Pauliina Lähdeaho, Johanna Soini (SN.); South Carelia Central Hospi-tal, Dr. Seppo Hovilehto (Inv.); Päijät-Häme Central Hospital, Dr. Pekka Loisa (Inv.), Alli Parviainen, Pirjo Tuomi (SN.); Vaasa Central Hospital, Dr. Simo-Pekka Koivisto, Dr. Raku Hautamäki (Inv.); Kanta-Häme Central Hospital, Dr. Ari Alaspää (Inv.), Tarja Heikkilä (SN.); Lappi Central Hospital, Dr. Outi Kiviniemi (Inv.), Esa Lintula (SN.); Keski-Pohjanmaa Central Hospital, Dr. Tadeusz Kaminski (Inv.), Jane Roiko (SN.); Kymenlaakso Central Hospital, Dr. Seija Alila, Dr. Jussi Pentti (Inv.), Reija Koskinen (SN.); Länsi-Pohja´s Central Hospital, Dr. Jorma Heikkinen (Inv.) Helsinki University Hospital, Jorvi Hospital, Dr. Jukka Vaahersalo, Dr. Tuomas Oksanen, Dr. Tero Varpula (Inv.), Anne Eronen, Teemu Hult, Taina Nieminen (SN.); Meilahti Hospital Medical ICU, Dr. Tom Bäcklund (Inv.), Leevi Kauhanen (SN.); Meilahti Hospital ICU, Dr. Kirsi-Maija Kaukonen, Dr. Ville Pettilä (Inv.), Leena Pettilä, Sari Sutinen (SN.); Turku University Hospital, Dr. Juha Perttilä, Dr. Keijo Leivo, Dr. Juha Grönlund (Inv.); Tampere University Hospital, Dr. Sanna Hoppu, Dr. Jyrki Tenhunen, Dr. Sari Karlsson (Inv.), Atte Kukkurainen, Simo Varila, Samuli Kortelainen, Minna-Liisa Peltola (SN.); Kuopio University Hospital, Dr. Pamela Hiltunen, Dr. Jouni Kurola, Dr. Esko Ruokonen (Inv.), Elina Halonen, Saija Rissanen, Sari Rahikainen (SN.); Oulu University Hospital, Dr. Risto Ahola, Dr. Tero Ala-Kokko (Inv.), Sinikka Sälkiö (SN.)

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Vaahersalo, J., Hiltunen, P., Tiainen, M. et al. Therapeutic hypothermia after out-of-hospital cardiac arrest in Finnish intensive care units: the FINNRESUSCI study. Intensive Care Med 39, 826–837 (2013). https://doi.org/10.1007/s00134-013-2868-1

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