1. Introduction Therapeutic hypothermia has been shown to improve survival and neurologic outcome in patients resuscitated after ventricular fibrillation arrest. Few studies have examined whether therapeutic hypothermia is effective outside the research setting, or with other presenting rhythms. Our institution, a large community teaching hospital, instituted a therapeutic hypothermia protocol in November 2006 for all resuscitated cardiac arrest patients. We sought to determine if our protocol would provide a similar mortality benefit. Secondarily, we sought to determine if neurological status on discharge would be improved after treatment with therapeutic hypothermia. We performed a before-and-after study from November 2006 to December 2010. Patients were cooled for 24 hours to 33 °C using an Alsius CoolGuard unit and femoral catheter. The same device was then used to re-warm patients at 0.5 °C/hr for 12 hours or until they reached 36.5 °C. Inclusion criteria were any adult non-pregnant patient who was unresponsive after resuscitation from cardiac arrest regardless of presenting rhythm and who survived to hospital admission. Exclusion criteria were hypotension (SBP <90), initial temperature < 30 °C, trauma, primary intracranial event, or active coagulopathy. Historical controls from November 2005 to November 2006 were identified from the electronic medical record, and met the same inclusion and exclusion criteria. Survival to hospital discharge was our primary outcome measure. Neuroloical status, determined by Glasgow-Pittsburgh cerebral performance category, was abstracted from the medical records. Category 1 or 2 was rated as good. Neurological outcome on discharge was improved in patients treated with therapeutic hypothermia, but did not reach statistical significance in our small patient cohort. Mortality rates were not statistically different between groups. A trend towards improved mortality was noted, especially among patients presenting with VF/VT arrest. Implementation of a Therapeutic Hypothermia Protocol in a Community Hospital Emergency Department Christine Kulstad, MD, David Barounis, MD, and Elise Lovell, MD Department of Emergency Medicine, Advocate Christ Medical Center, Oak Lawn, Illinois We collected data on a relatively small number of patients. We obtained data retrospectively by chart review. Our study was non-randomized. Some patients who met inclusion criteria were not treated based on physician judgment which may have produced a selection bias in our study patients. Our data was collected from only one institution. Results Seventy-nine patients were treated with therapeutic hypothermia with a mortality rate of 70.9% (95% CI 60- 80%). Mortality was 72.3% in 47 historical control patients (95% CI 57-86%). Nine patients, 11.4% (95% CI 6.1-20.3%), in the hypothermia group had good neurological outcome at discharge compared to none in the control group. In patients presenting with VF/VT, mortality was 56% (95% CI 6.1-20.3%) in the therapeutic hypothermic group, compared with 67% (95% CI 28-100%) in the control group. Good neurological outcome was seen in 20% (95% CI 8.9- 39.1%) therapeutic hypothermia patients, compared with 0 (95% CI 0-30%) control patients. Sixty-eight patients met inclusion criteria, but were not enrolled. Documented reasons included presumed infection, immediate transfer to cardiac catheterization lab, poor baseline function, and withdrawal of care in the ED. Methods Conclusions Limitations References Bernard SA et al. Treatment of comatose survivors of out of-hospital cardiac arrest with induced hypothermia. N Engl J Med. 2002; Feb 21;346(8):557-63. Hypothermia after Cardiac Arrest Study Group. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med. 2002; Feb 21;346(8):549-56. Therapeutic Hypothermia After Cardiac Arrest: An Advisory Statement by the Advanced Life Support Task Force of the International Liason Committee on Resuscitation. Circulation 2003;108:118-21.