Cooling unconscious cardiac arrest survivors can increase survival and has a cost effectiveness comparable to other widely accepted treatments in modern health care, researchers report in Circulation: Cardiovascular Quality and Outcomes.
Out-of-hospital cardiac arrest – in which the heart stops effectively pumping blood through the body – annually occurs in about 300,000 adults in the United States.
“Therapeutic hypothermia is the only post-resuscitation therapy shown to improve both survival and reduce disability after cardiac arrest,” said lead author Raina M. Merchant, M.D., M.S., a Robert Wood Johnson Foundation Clinical Scholar and emergency medicine physician at the University of Pennsylvania School of Medicine in Philadelphia.
“Since 2003, the American Heart Association has recommended that comatose (unconscious) patients with spontaneous circulation after out-of-hospital ventricular fibrillation (VF) cardiac arrest should receive therapeutic hypothermia,” Merchant said. “Despite repeating this recommendation in the 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, along with other studies that show its benefits, therapeutic hypothermia hasn’t been adopted as quickly as one would hope. We thought it would be a good idea to determine whether cost should be a barrier to its use.”
With therapeutic hypothermia, a patient’s body temperature is cooled and the patient is monitored so that their internal body temperature remains between 32 and 34 degrees centigrade (89.6 to 93.2 degrees Fahrenheit) for at least 12 to 24 hours. Cooling blankets, one of several technologies used to accomplish therapeutic cooling, were the focus of the current analysis.
Researchers used a complex mathematical design to measure quality-adjusted survival after cardiac arrest, cost of hypothermia treatment, cost of post-hospital discharge care and incremental cost-effectiveness ratios. Factors affecting costs included additional nursing care required during cooling treatment, extra time spent in the intensive care unit and post-discharge care required.
Merchant said, “Quality adjusted life year calculations were based on previous studies of patients with cardiac arrest.”
Quality adjusted life years (QALY) are a measurement of health outcomes that are calculated by combining quality of life and life expectancy.The incremental cost-effectiveness ratio (ICER) for therapeutic hypothermia compared with conventional care (post-resuscitation care without hypothermia) was $47,168/ (QALY), Merchant said.
“We found that even at extreme estimates for costs, the cost-effectiveness of hypothermia remained less than $100,000/QALY in more than 91 percent of our simulations,” she said.
Researchers used data from two landmark papers published in 2002 by the Hypothermia After Cardiac Arrest (HACA) study group, which reported that therapeutic hypothermia improves survival and neurologic outcomes in comatose resuscitated cardiac arrest patients. In addition, researchers used information from cooling device companies and consultation with resuscitation experts.
In comparison, other studies estimated the ICER of kidney dialysis at $55,000/QALY. Public access defibrillation — the placement of automated external defibrillators (AEDs) in public places — has an ICER of $44,000/QALY. Placing AEDs on all U.S. commercial aircraft has an estimated cost of $94,700/QALY, researchers added.
“We showed that therapeutic hypothermia is a good value for the cost,” Merchant said. “In fact, even if a hospital had only one patient eligible for hypothermia therapy annually, and considerable post-resuscitation care costs resulted for survivors, the cost-effectiveness is consistent with many widely accepted healthcare interventions.”
One of the limitations of the current study is the lack of long-term outcomes data, which Merchant hopes will be overcome with future research.
Co-authors are Lance B. Becker, M.D.; Benjamin S. Abella, M.D., M.Phil.; David A. Asch, M.D., M.B.A. and Peter W. Groeneveld, M.D., M.S. Individual author disclosures are on the manuscript.
The study was funded by the Robert Wood Johnson Foundation’s Clinical Scholars program at the University of Pennsylvania (Dr. Merchant), and by a Career Development Transition Award from the Veterans Affairs Health Services Research and Development Service (Dr. Groeneveld).
Statements and conclusions of study authors published in American Heart Association scientific journals are solely those of the study authors and do not necessarily reflect the association’s policy or position. The association makes no representation or guarantee as to their accuracy or reliability. The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events. The association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and device corporations are available at www.americanheart.org/corporatefunding.
Tagni McRae | EurekAlert!
Rutgers-led innovation could spur faster, cheaper, nano-based manufacturing
14.02.2018 | Rutgers University
New study from the University of Halle: How climate change alters plant growth
12.01.2018 | Martin-Luther-Universität Halle-Wittenberg
Animal photoreceptors capture light with photopigments. Researchers from the University of Göttingen have now discovered that these photopigments fulfill an...
On 15 March, the AWI research aeroplane Polar 5 will depart for Greenland. Concentrating on the furthest northeast region of the island, an international team...
The world’s second-largest ice shelf was the destination for a Polarstern expedition that ended in Punta Arenas, Chile on 14th March 2018. Oceanographers from...
At the 2018 ILA Berlin Air Show from April 25–29, the Fraunhofer Institute for Laser Technology ILT is showcasing extreme high-speed Laser Material Deposition (EHLA): A video documents how for metal components that are highly loaded, EHLA has already proved itself as an alternative to hard chrome plating, which is now allowed only under special conditions.
When the EU restricted the use of hexavalent chromium compounds to special applications requiring authorization, the move prompted a rethink in the surface...
At the ILA Berlin, hall 4, booth 202, Fraunhofer FHR will present two radar sensors for navigation support of drones. The sensors are valuable components in the implementation of autonomous flying drones: they function as obstacle detectors to prevent collisions. Radar sensors also operate reliably in restricted visibility, e.g. in foggy or dusty conditions. Due to their ability to measure distances with high precision, the radar sensors can also be used as altimeters when other sources of information such as barometers or GPS are not available or cannot operate optimally.
Drones play an increasingly important role in the area of logistics and services. Well-known logistic companies place great hope in these compact, aerial...
16.03.2018 | Event News
13.03.2018 | Event News
08.03.2018 | Event News
16.03.2018 | Earth Sciences
16.03.2018 | Physics and Astronomy
16.03.2018 | Life Sciences