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Published on: November 21, 2017
Targeted Temperature Management for Cardiac Arrest with Nonshockable Rhythm
Jean-Baptiste Lascarrou1, Hamid Merdji1, Amélie Le Gouge1
1From Médecine Intensive Réanimation, University Hospital Center, Nantes (J.-B.L., N.B., J.R.), the Paris Cardiovascular Research Center, INSERM Unité 970 (J.-B.L., A.C.), the Medical Intensive Care Unit, Cochin University Hospital Center (A.C.), and the AfterROSC Network (J.-B.L., A.C., N.P., S.L.), Paris, Université de Strasbourg, Faculté de Médecine (H.M.), Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Service de Médecine Intensive Réanimation (H.M.), and Unité Mixte de Recherche (UMR) 1260, Regenerative Nano Medecine, INSERM, Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg (H.M.), Strasbourg, INSERM Centres d'Investigation Clinique (CIC) 1415, Centre Hospitalier Régional Universitaire de Tours (A.L.G., B.G.), the Medical Intensive Care Unit, University Hospital Center (P.-F.D.), INSERM UMR 1100-Centre d'Etude des Pathologies Respiratoires, Tours University (P.-F.D.), and Université de Tours (B.G.), Tours, the Medical-Surgical Intensive Care Unit, District Hospital Center, La Roche-sur-Yon (G.C.), the Medical Intensive Care Unit, South Brittany General Hospital Center, Lorient (G.G.), Médecine Intensive Réanimation, Centre Hospitalier Universitaire Lille, and Université de Lille, Faculté de Médicine, Lille (P.G.), the Medical Intensive Care Unit, University Hospital Center, Clermond-Ferrand (E.C.), the Medical Intensive Care Unit, Regional Hospital Center, Orleans (T.B.), the Medical Intensive Care Unit, University Hospital Center, INSERM CIC 1402, Équipe ALIVE, and Université de Poitiers, Faculté de Médecine et de Pharmacie de Poitiers, Poitiers (J.-P.F.), the Medical Intensive Care Unit, University Hospital Center, Angers (P.A.), Service de Réanimation Polyvalente, University Hospital Center, and CIC 1435, University Hospital Center, Limoges (N.P.), the Medical-Surgical Intensive Care Unit, General Hospital Center, Le Mans (M.L.), the Medical-Surgical Intensive Care Unit, General Hospital Center, Argenteuil (G.P.), the Medical Intensive Care Unit, University Hospital Center, Dijon (J.-P.Q.), the Medical-Surgical Intensive Care Unit, General Hospital Center, Roanne (J.-C.C.), the Medical-Surgical Intensive Care Unit, General Hospital Center, Annecy (M.S.), the Medical-Surgical Intensive Care Unit, Versailles Hospital, Versailles (S.L.), the Medical-Surgical Intensive Care Unit, General Hospital Center, Saint Brieuc (J.L.), the Medical-Surgical Intensive Care Unit, General Hospital Center, Lens (D.T.), the Medical-Surgical Intensive Care Unit, General Hospital Center, Angouleme (A. Desachy), the Medical-Surgical Intensive Care Unit, General Hospital Center, Rodez (A. Delahaye), the Medical-Surgical Intensive Care Unit, General Hospital Center, Saint Malo (V.B.), the Medical-Surgical Intensive Care Unit, General Hospital Center, Montauban (S.V.), and the Medical Intensive Care Unit, University Hospital Center, Point-a-Pitre (F.M.) - all in France.
Moderate therapeutic hypothermia improved neurologic outcomes in cardiac arrest patients with nonshockable rhythms. This finding suggests hypothermia is beneficial for this specific patient group, enhancing survival with favorable neurologic function.
Area of Science:
- Cardiology
- Neurology
- Critical Care Medicine
Background:
- Moderate therapeutic hypothermia is recommended for improving neurologic outcomes in adults with persistent coma after out-of-hospital cardiac arrest.
- The effectiveness of hypothermia in patients with nonshockable rhythms (asystole or pulseless electrical activity) remains debated.
Purpose of the Study:
- To compare the effectiveness of moderate therapeutic hypothermia versus targeted normothermia in patients with coma after cardiac arrest with a nonshockable rhythm.
- To assess the impact on survival with favorable neurologic outcome at 90 days.
Main Methods:
- An open-label, randomized controlled trial was conducted.
- 581 patients were randomized to either moderate therapeutic hypothermia (33°C for 24 hours) or targeted normothermia (37°C).
- The primary outcome was survival with a favorable neurologic outcome (Cerebral Performance Category score of 1 or 2) at day 90.
Main Results:
- A higher percentage of patients in the hypothermia group (10.2%) survived with a favorable neurologic outcome compared to the normothermia group (5.7%) at day 90 (P=0.04).
- There was no significant difference in 90-day mortality between the hypothermia and normothermia groups.
- The incidence of prespecified adverse events did not differ significantly between the groups.
Conclusions:
- Moderate therapeutic hypothermia (33°C for 24 hours) led to a higher rate of favorable neurologic outcomes at 90 days in comatose patients resuscitated from cardiac arrest with a nonshockable rhythm.
- Therapeutic hypothermia appears beneficial for improving neurologic recovery in this specific patient population.
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