Abstracts

Rationale: Gender- and race-based differences in disease incidence and prevalence, treatment and outcomes has been described previously in a number of areas of medicine.  Recognizing and understanding these differences has the potential improve patient care and outcomes by refining our approach to and treatment of patients.  At our institution, there is a standardized protocol in place for targeted temperature management (TTM) post-cardiac arrest that includes EEG monitoring to assist with prognostication.  In this study, we set out to investigate whether there are differences in outcomes for these post-cardiac arrest TTM patients based on gender, race or other factors.  This was done with the desire to improve our ability to prognosticate and to counsel families. Methods: Outcomes data was collected on over 300 patients at our institution who suffered cardiac arrest and underwent post-cardiac arrest TTM per our institutional protocol.  The data collected on patient characteristics included age, gender, racial group (Caucasian, Black, Asian or Hispanic), while outcomes measures included condition at discharge (Cerebral Performance Category 1-5) and discharge destination (home, home with services, short or long-term rehabilitation center, or nursing home). Results: Analysis of the data collected shows that there is a statistically significant difference in outcomes for patients who undergo post-cardiac arrest TTM based on patient demographics.  In particular, outcomes are worse for non-Caucasian patients, with a higher rate of mortality and fewer patients discharged to home: among Caucasians, 85/246 (34.5%) had favorable outcomes, while for non-Caucasians, only 26/121 (21.5%) had favorable outcomes (with statistical significance of 0.011 using Fisher's exact test). More non-Caucasian patients presented with a highly malignant EEG within the first 24 hours or CT evidence for anoxic brain injury than Caucasian patients (p=0.037); most of these patients had poor outcome (129 of 153, CPC 4 or 5) with no difference in race. In patients. In the remaining patients, more Caucasian patients had good outcome (CPC 1-3, 74%) as compared to non-Caucasians (50%, p=0.0022). Conclusions: This study reveals a racial gap in outcomes for patients who suffer cardiac arrest, despite an institutional protocol to initiate TTM on all post-cardiac arrest patients, even when controlling for poor CT and EEG on initial presentation.  Although differences in outcomes based on race had previously been reported in other fields of medicine, it has not previously been described for post-cardiac arrest targeted temperature management patients.  Understanding this difference will improve the accuracy of our prognostication and ability to counsel families.  The factors that influence this difference in outcomes remain to be elucidated; this will be the subject of future work in the hopes of improving the outcomes for the patients in the future. Funding: None