Therapeutic hypothermia after cardiac arrest caused by self-inflicted intoxication: a multicenter retrospective cohort study.

Abstract

INTRODUCTION: The aim of this study was to describe the epidemiology and outcomes

of patients with therapeutic hypothermia after out-of-hospital cardiac arrest

(OHCA) caused by self-inflicted intoxication. METHODS: We performed a multicenter

retrospective registry-based study of adult OHCA patients presenting to 24

hospitals over 6 years across South Korea. Data included demographics,

resuscitation variables, postresuscitation variables, and self-inflicted

intoxicants. Neurologic outcomes were categorized according to the

Glasgow-Pittsburgh Cerebral Performance Categories (CPC) scale and were

dichotomized as either good discharge outcomes (CPC 1 and 2) or poor discharge

outcomes (CPC 3-5). RESULTS: A total of 930 OHCA cases were identified, 24 (2.6%)

of which were classified as cardiac arrest caused by acute intoxication. The mean

age of cases was 57.2 +/- 12.9 years. The mean time from collapse to return of

spontaneous circulation was 35.4 +/- 18.7 minutes. The presenting rhythm was

pulseless electrical activity in 6 patients (25%) and asystole in 18 patients

(75%). Eleven patients (46%) survived to hospital discharge, and of these, good

discharge outcomes (CPC 1 and 2) were achieved in 21% (5/24). For pesticide

intoxication, the survival-to-discharge rate was 62% (8/13), and the rate of good

neurologic outcome was 23% (3/13). CONCLUSION: Patients with OHCA caused by

self-inflicted intoxication represented 2.6% of all OHCA patients. They showed a

high rate of unwitnessed cardiac arrest and a very low rate of bystander

cardiopulmonary resuscitation. Pesticides were the main cause of cardiac arrest,

and these cases had a very high discharge to survival rate.