Temperature Control After In-Hospital Cardiac Arrest: A Randomized Clinical Trial

Area of Science:

• Cardiology
• Intensive Care Medicine
• Neurology

Background:

• In-hospital cardiac arrest (IHCA) presents significant mortality and morbidity challenges.
• Therapeutic hypothermia is a potential intervention to improve outcomes post-cardiac arrest.
• Previous studies have shown mixed results regarding the efficacy of hypothermia after IHCA.

Purpose of the Study:

• To evaluate the effect of hypothermic temperature control versus normothermia on mortality and functional outcomes in patients following IHCA.
• To compare 180-day all-cause mortality and functional status between hypothermia and normothermia groups.

Main Methods:

• A multicenter, randomized controlled trial involving 249 patients after IHCA.
• Comparison of hypothermic temperature control (32-34°C for 24 hours) against normothermia.
• Primary endpoint: 180-day all-cause mortality; Secondary endpoints: in-hospital mortality and favorable functional outcome (Cerebral Performance Category score ≤2).

Main Results:

• No significant difference in 180-day all-cause mortality between hypothermia (72.5%) and normothermia (71.2%) groups (RR 1.03, P=0.822).
• In-hospital mortality and favorable functional outcomes at 180 days were also similar between the groups.
• The study was prematurely terminated due to futility, with a sample size of 249 patients.

Conclusions:

• Hypothermic temperature control did not demonstrate a survival or functional benefit compared to normothermia in comatose patients post-IHCA.
• The Hypothermia After Cardiac Arrest in-hospital (HACA) trial was underpowered to detect potential clinical differences.
• Further research may be needed to clarify the role of therapeutic hypothermia in specific IHCA patient subgroups.