Public health impact of full implementation of therapeutic hypothermia after cardiac arrest

Abstract

Aim: Induced hypothermia improves outcomes in patients resuscitated successfully after cardiac arrest due to ventricular fibrillation. However, a minority of US physicians currently use the therapy. The aim of this study was to project the public health impact of implementing hypothermia in all eligible US out-of-hospital cardiac arrest (OHCA) survivors.

Methods: The number of OHCA patients expected to have a good outcome after hypothermia was calculated using a linear model. Literature-derived input variables included OHCA incidence rates and US 2000 census data, percent with return to spontaneous circulation (ROSC), percent eligible for hypothermia, and the expected benefit from hypothermia. Sensitivity analyses were performed to calculate a plausible range around the reference case.

Results: An additional 2298 US patients per year are expected to have a good neurological outcome if US physicians implement hypothermia fully in comatose survivors of OHCA. The two-way sensitivity analyses found that this number ranged from 766 to 5171 patients. This model is similarly sensitive to varying the incidence of OHCA, percent with ROSC, percent of patients eligible for hypothermia, and the number needed to treat.

Conclusions: If US physicians adopt therapeutic hypothermia fully in eligible patients with OHCA, 2298 additional patients per year would be expected to achieve a good neurological outcome, a substantial public health impact. Barriers to adoption should be researched and addressed to increase acceptance and use by US physicians.