HACA Trial

NEJM

February 21, 2002

Mild Therapeutic Hypothermia to Improve the Neurologic Outcome after Cardiac Arrest

Summarized by: 

Mazen Kherallah

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.

HACA Trial