Background: Therapeutic hypothermia (TH) after cardiac arrest protects from neurological sequels and death and is recommended in guidelines. The Hypothermia Registry was founded to the monitor outcome, performance and complications of TH.Methods: Data on out‐of‐hospital cardiac arrest (OHCA) patients admitted to intensive care for TH were registered. Hospital survival and long‐term outcome (6–12 months) were documented using the Cerebral Performance Category (CPC) scale, CPC 1–2 representing a good outcome and 3–5 a bad outcome.Results: From October 2004 to October 2008, 986 TH‐treated OHCA patients of all causes were included in the registry. Long‐term outcome was reported in 975 patients. The median time from arrest to initiation of TH was 90 min (interquartile range, 60–165 min) and time to achieving the target temperature (≤34 °C) was 260 min (178–400 min). Half of the patients underwent coronary angiography and one‐third underwent percutaneous coronary intervention (PCI). Higher age, longer time to return of spontaneous circulation, lower Glasgow Coma Scale at admission, unwitnessed arrest and initial rhythm asystole were all predictors of bad outcome, whereas time to initiation of TH and time to reach the goal temperature had no significant association. Bleeding requiring transfusion occurred in 4% of patients, with a significantly higher risk if angiography/PCI was performed (2.8% vs. 6.2%P=0.02).Conclusions: Half of the patients survived, with >90% having a good neurological function at long‐term follow‐up. Factors related to the timing of TH had no apparent association to outcome. The incidence of adverse events was acceptable but the risk of bleeding was increased if angiography/PCI was performed.

Early identification of predictors for a poor long-term outcome in patients who survive the initial phase of out-of-hospital cardiac arrest (OHCA) may facilitate future clinical research, the process of care and information provided to relatives. The aim of this study was to determine the association between variables available from the patient’s history and status at intensive care admission with outcome in unconscious survivors of OHCA. Using the cohort of the Target Temperature Management trial, we performed a post hoc analysis of 933 unconscious patients with OHCA of presumed cardiac cause who had a complete 6-month follow-up. Outcomes were survival and neurological function as defined by the Cerebral Performance Category (CPC) scale at 6 months after OHCA. After multiple imputations to compensate for missing data, backward stepwise multivariable logistic regression was applied to identify factors independently predictive of a poor outcome (CPC 3–5). On the basis of these factors, a risk score for poor outcome was constructed. We identified ten independent predictors of a poor outcome: older age, cardiac arrest occurring at home, initial rhythm other than ventricular fibrillation/tachycardia, longer duration of no flow, longer duration of low flow, administration of adrenaline, bilateral absence of corneal and pupillary reflexes, Glasgow Coma Scale motor response 1, lower pH and a partial pressure of carbon dioxide in arterial blood value lower than 4.5 kPa at hospital admission. A risk score based on the impact of each of these variables in the model yielded a median (range) AUC of 0.842 (0.840–0.845) and good calibration. Internal validation of the score using bootstrapping yielded a median (range) AUC corrected for optimism of 0.818 (0.816–0.821). Among variables available at admission to intensive care, we identified ten independent predictors of a poor outcome at 6 months for initial survivors of OHCA. They reflected pre-hospital circumstances (six variables) and patient status on hospital admission (four variables). By using a simple and easy-to-use risk scoring system based on these variables, patients at high risk for a poor outcome after OHCA may be identified early.

Quiz Ref ID Brain injury is the primary cause of death for patients treated in an intensive care unit after out-of-hospital cardiac arrest (CA).^1,2 Severe neurologic impairment in long-term survivors is, however, rare, and most appear to have little or no disability when assessed with recommended outcome measures, such as the Cerebral Performance Category (CPC) and modified Rankin scale (mRS).³ Quiz Ref ID Good quality of life in survivors after CA has been reported⁴ to be similar to that of the general population.^5,6 This finding notwithstanding, cognitive impairment has been detected in as many as half the survivors when assessed by more detailed neuropsychological investigations,⁷ suggesting reduced quality of life⁸ and increased caregiver strain.⁹