PERCUTANEOUS CORONARY INTERVENTION IS ASSOCIATED WITH UNNECESSARY DELAYS IN INITIATION OF MILD THERAPEUTIC HYPOTHERMIA IN PATIENTS WITH CARDIAC ARREST

INTRODUCTION: Mild therapeutic hypothermia (TH) has been found effective in improving neurological prognosis of comatose patient after cardiac arrest (CA). Delay in initiating TH has been associated with poor neurological outcomes. Cardiac catheterization (CC) is often performed in patients with CA. The impact of CC on timing of TH and the ideal timing of CC in patients with CA need further evaluation. METHOD: We conducted a retrospective study including all patients who underwent TH after CA between November 1st 2009 and October 20th 2012 in a tertiary care center with PCI facilities. Patients were separated in two groups based on delay of initiation of TH from CA ( 180 min). We identified factors associated with delay in initiating TH using logistic regression. RESULTS: Forty-two patients underwent TH during the study period. Two patients were excluded because of missing values. Selected patient characteristics are shown in the Table. TH was initiated in the referral hospital in 5 (12%) patients. Median time of initiation of TH from CA was 205 (169, 297) minutes. Performing imaging tests before cooling was associated with delayed initiation of TH: cardiac ultrasound (329 222 versus 204 82 minutes; p 1⁄4 0.01), computerized tomography scan (309 208 versus 202 77 minutes; p 1⁄4 0.02). On average, initiation of TH was delayed for 61 min in patients undergoing CC first when compared to patients who were cooled first (268 min vs 207 min). After exclusion of patients in whom TH was initiated in the referral hospital, factors independently associated with delay in initiation of TH of> 180 min were: presentation during daytime (p1⁄40.002), being transferred from a referral hospital (p1⁄40.04) and undergoing CC before TH (p1⁄40.06). TH was initiated immediately prior to CC in 6 patients. Time to reach target temperature was longer in these patients compared to other patients (215 min vs 128 min; p1⁄40.03). No ischemic complication was reported in patients undergoing PCI during TH. Overall, inhospital mortality was 50%. In survivors, neurological outcome was good (CPC 1 or 2) in 17 out of 20 patients. CONCLUSION: In this single-center registry of patients sustaining a CA, CC was associated with a substantial delay in initiation of TH. Cooling at the time of CC was feasible and while it lengthens the time to reach target temperature, it was not associated with adverse ischemic outcomes.