NEJM
February 21, 2002
Mild Therapeutic Hypothermia to Improve the Neurologic Outcome after Cardiac Arrest
Mazen Kherallah
Summarized by:
What was the research question?
·Does mild systemic hypothermia increase the rate of neurologic recovery after resuscitation from cardiac arrest due to ventricular fibrillation?
How did they do it?
A multicenter trial with blinded assessment of the outcome in Nine centers in five European countries participated in the study.
275 patients who had return of spontaneous circulation after resuscitation for cardiac arrest due to ventricular fibrillation were randomized to undergo therapeutic hypothermia (target temperature, 32°C to 34°C, measured in the bladder) over a period of 24 hours (136 patients) or standard treatment with normothermia (137 patients).
Patients who responded to verbal commands post arrest were excluded.
The primary end point was a favorable neurologic outcome within six months after cardiac arrest based on Pittsburgh cerebral-performance scale 1-2 [ 1: good recovery, 2: moderate disability, 3: severe disability, 4: vegetative state, and 5: death).
Secondary end points were mortality within six months and the rate of complications within seven days.
What did they find?
Favorable neurologic outcome was significantly better in the hypothermia group compared to the normothermia group (55% vs. 39%, P=0.009).
Mortality at six months was also significantly better in the hypothermia group compared to the normothermia group (41% vs. 55%, P=0.02)
The complication rate did not differ significantly between the two groups. Minor/major bleed (26% vs. 19%), pneumonia (37% vs. 29%), and sepsis (13% vs. 7%).
What does it mean?
Therapeutic mild hypothermia increased the rate of favorable neurological outcome and reduced mortality in patients who were successfully resuscitated after cardiac arrest due to ventricular fibrillation.
Hypothermia became a standard of care for all patients who had ROSC after cardiac arrest if there was no contra-indication.