The effect of hypothermia dose on vasopressor requirements and outcome after cardiac arrest

Huynh N et al. – Therapeutic hypothermia (TH) delivery is not associated with vasopressor requirement. TH “dose” is not associated with total cumulative vasopressor index (CVI), survival, or good outcome. Vasopressor or inotropic requirement should not contraindicate TH use.

Methods

• Chart review of in– and out–of–hospital cardiac arrests between 1/1/2005 and 3/15/2010.
• Data included demographic information, category of post–cardiac arrest illness severity
• Awake
• Coma (not following commands but intact brainstem responses)+mild cardiopulmonary dysfunction (SOFA [Sequential Organ Failure Assessment] cardiac+respiratory score <4)
• Coma+moderate–severe cardiopulmonary dysfunction (SOFA cardiac+respiratory score >=4)
• Coma without brainstem reflexes), cumulative vasopressor index (CVI), inotrope use, survival, and neurologic outcome
• The “dose” of TH (hours*temperature below threshold) was calculated using thresholds of ≤34°C and ≤35°C.
• Data were analyzed using descriptive statistics, Student's–t test, Wilcoxon test, and chi–squared analysis.
• Linear and logistic regression evaluated the effect of hypothermia “dose” on total CVI, survival and neurologic outcome.

Results

• Among 361 comatose patients, 233 (65%) received TH.
• Vasopressor administration (measured by CVI) was higher in normothermic subjects (60.2% vs. 46.4%; p=0.016).
• Using a 34°C threshold, SOFA respiratory subscore and PEA arrest predicted total CVI.
• Using a 35°C threshold, severity of coma, SOFA respiratory subscore, PEA arrest and use of inotropic agents in addition to vasopressors predicted total CVI.
• Initial motor examination predicted survival and neurologic outcome, while TH “dose” did not.

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