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Currently, the guidelines on targeted therapeutic hypothermia (TH) recommend that intubated patients with treatment to initiate within 6 hours after cardiac arrest. It is unclear whether early initiation of TH would correspond to have better neurologic outcome. The aim of this study was to determine the rate of good neurologic outcome according to the timing of initiating TH in out-of-hospital (OHCA) patients.
122 patients who were comatose after return of spontaneous circulation (ROSC) and received TH were retrospectively enrolled between January 2013 and April 2017. The primary endpoint was good neurologic outcome defined as a cerebral performance category score of 1 or 2. The timing of initiating TH was calculated as time interval between time of ROSC and starting TH.
118 patients were successfully treated with TH, and 4 were excluded due to the known timing of initiating TH. The median timing of initiating TH was 284 min (171-418) and 30 (25.4%) patients had good neurologic outcome. The rate of good neurologic outcome in the groups on timing of initiating TH divided by quartile were 28.6%, 34.5%, 14.8%, and 28.6% (p=0.401), and the results were not different for initial shockable rhythm (p=0.617) and non-shockable rhythm (p=0.737). Multiple logistic regression showed that low flow time was associated with good neurologic outcome (p=0.044), however, timing of initiating TH was not (p=0.602).
Although shorter low flow time was associated with good neurologic outcome in OHCA patients received with TH, the shorter timing of initiating TH did not improve neurologic outcome. It is reasonable to initiate TH within 6hrs in ROSC patients as current guideline recommended.
OTHER: Quality, Guidelines and Appropriateness Criteria