"Mild Therapeutic Hypothermia to Improve the Neurologic Outcome after Cardiac Arrest". The New England Journal of Medicine. Published date not stated.
Links to original sources: Wiki Journal Post Full Journal Article
Contents
1. Clinical Question 2. Bottom Line 3. Major Points 4. Guidelines 5. Design 6. Population 6.1 Inclusion Criteria 6.2 Exclusion Criteria 6.3 Baseline Characteristics 7. Interventions 8. Outcomes 8.1 Primary Outcome 8.2 Secondary Outcomes 9. Funding 10. Further Reading
Does mild systemic hypothermia increase the rate of neurologic recovery after resuscitation from cardiac arrest due to ventricular fibrillation?
Mild systemic hypothermia (32°C to 34°C) for 24 hours improves neurologic outcomes and reduces mortality at six months among patients successfully resuscitated from cardiac arrest due to ventricular fibrillation.
The study demonstrated the effectiveness of therapeutic hypothermia in patients who had a cardiac arrest due to ventricular fibrillation, showing that it increased the chance of good neurologic recovery (defined as a cerebral-performance category of 1 or 2) and decreased mortality at six months. This study contributed to the establishment of therapeutic hypothermia as a standard of care in post-cardiac arrest management for appropriate patients.
As of the knowledge cutoff date, therapeutic hypothermia was recommended in guidelines such as those by the AHA/ERC for comatose patients after out-of-hospital cardiac arrest when the initial rhythm was ventricular fibrillation.
- Multicenter, randomized, controlled trial with blinded assessment of the outcome. - N=275 patients with cardiac arrest due to ventricular fibrillation. - Hypothermia group (n=137) vs. Normothermia group (n=138). - Enrollment from March 1996 to January 2001. - Analysis: Intention-to-treat.
Inclusion Criteria
- Witnessed cardiac arrest - Initial rhythm of ventricular fibrillation or non-perfusing ventricular tachycardia - Presumed cardiac origin of arrest - Age between 18 and 75 years - Resuscitation attempts started 5 to 15 minutes from collapse by emergency medical personnel - Restoration of spontaneous circulation within 60 minutes from collapse
Exclusion Criteria
- Tympanic-membrane temperature below 30°C on admission - Comatose state due to central nervous system depressants - Pregnancy - Response to verbal commands post-resuscitation - Severe hypotension or hypoxemia post-resuscitation - Terminal illness pre-arrest - Cardiac arrest after arrival of medical personnel - Known coagulopathies
Baseline Characteristics
Groups were generally similar, although patients in the normothermia group were more likely to have histories of diabetes and coronary heart disease and to have received bystander CPR.
- Hypothermia group was cooled to a targeted body temperature of 32°C to 34°C for 24 hours using an external cooling device, followed by passive rewarming. - Normothermia group received standard care with maintenance of normal body temperature.
Primary Outcome
- Favorable neurologic outcome at six months, defined as cerebral-performance category of 1 or 2.
- Mortality at six months. - Rate of complications within seven days post-cardiac arrest.
Mortality and neurologic outcome were significantly improved in the hypothermia group. The rate of complications such as bleeding, pneumonia, sepsis, and arrhythmias did not significantly differ between groups.
Supported by grants from the European Union, the Austrian Ministry of Science and Transport, and the Austrian Science Foundation. The cooling device was provided by Kinetic Concepts.
Articles cited in text above for more information on cardiac arrest and therapeutic hypothermia practices.