Treatment of comatose survivors of in-hospital cardiac arrest with extended endovascular cooling method for 72 h: a propensity score-matched analysis

Abstract

Abstract Aims Targeted temperature management (TTM) is recommended for at least 24 h in comatose survivors of in-hospital cardiac arrest (IHCA) after the return of spontaneous circulation (ROSC); however, whether an extension for 72 h leads to better neurological outcomes is uncertain. Methods We included data from the Qilu Hospital of Shandong University between July 20, 2019 and June 30, 2022. Unconscious patients who had ROSC lasting >20 consecutive min and received endovascular cooling (72 h) or normothermia treatment were compared in terms of survival-to-discharge and favorable neurological survival. Propensity score matching was employed to formulate balanced 1:3 matched patients. Results In total, 2,084 patients were included. Sixteen patients received extended endovascular cooling and 48 matched controls received normothermia therapy. Compared with the normothermia group, patients who received prolonged endovascular cooling had a higher survival-to-discharge rate. However, good neurological outcomes did not differ significantly. Before matching, Cox regression analysis, using mortality as the event, showed that extended endovascular cooling independently affected the survival of IHCA patients. Conclusions Among comatose patients who had been resuscitated from IHCA, the use of endovascular cooling for 72 h might confer a benefit on survival-to-discharge.