Neurologic consultation and use of therapeutic hypothermia for cardiac arrest

Abstract

Objective: To determine whether neurologic consultation influences the use of therapeutic hypothermia.

Methods: We identified adult patients treated for cardiac arrest from October 2009 through September 2015 at 149 academic medical centers and their affiliate hospitals using discharge diagnosis codes in Vizient database. Neurology consultation was defined as a neurologist participating in patient care at any point during the hospitalization. Use of therapeutic hypothermia was identified using procedure codes. We used multivariable models to evaluate the association between neurologic consultation and therapeutic hypothermia before and after adjustment for patient baseline characteristics and hospital factors including inpatient volume and relative volume of cardiac arrest cases.

Results: We identified 136,830 hospitalizations for cardiac arrest. The 9,336 (6.8%) encounters involving a neurologist had higher severity of illness, longer hospital stay, and longer intensive care unit stay. There were 5,034 (3.7%) encounters where patients underwent therapeutic hypothermia. Hypothermia use was significantly more common when neurologists were involved during hospitalization (7.9% vs. 3.4%; OR 2.44, 95% CI 2.2-2.6; p<0.01). After adjustment, neurologic consultation continued to be associated with the use of therapeutic hypothermia (adjusted OR 2.5, 95% CI 2.3-2.8), particularly among hospitals in the highest quartile of total inpatient volume (OR 4.6, 95% CI 4.0-5.3). Lower in-hospital mortality was also associated with neurological consultation after adjusting for therapeutic hypothermia (59.2% vs. 61.3%, p<0.01).

Conclusions: The involvement of a neurologist in cardiac arrest patients is associated with increased use of therapeutic hypothermia, though therapeutic hypothermia for cardiac arrest likely remains underutilized.

Keywords: Anoxic-Ischemic encephalopathy; Cardiac arrest; Cardiopulmonary resuscitation; Health systems research; Neurocritical care; Therapeutic hypothermia.