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December 12, 2019

Targeted Temperature Management for Cardiac Arrest with Nonshockable Rhythm.

Mazen Kherallah

Summarized by: 

What was the research question?

  • In survivors of cardiac arrest due to non-shockable rhythm, does moderate hypothermia with a target temperature of 33°C improve outcome compared to normothermia and a target temperature of 37°C ?

How did they do it?

  • An open-label, randomized, controlled, and blinded outcome assessment trial in 25 intensive care units (ICUs) in France.

  • 581 comatose patients who survived non-shockable cardiac arrest were randomized to undergo moderate therapeutic hypothermia (33°C during the first 24 hours) (284 patients) or normothermia (37°C) (297 patients).

  • Primary outcome was 90-day survival rate with favorable neurologic outcome using Cerebral Performance Category (CPC) scale (score of 1 or 2).

  • Secondary outcomes included 90-day mortality and adverse events.

What did they find?

  • At 90 days, survival with a favorable neurologic function was significantly higher in the hypothermia group compared to the normothermia group (10.2% vs. 5.7%, P=0.04, NNT 22).

  • 90-day mortality was not significantly different between the hypothermia group and the normothermia group (81.3% and 83.2%).

  • The incidence of prespecified adverse events did not differ significantly between groups.

Are there any limitations?

  • Using a deeper sedation in the hypothermia group maybe a confounder in t study.

  • Authors did not mention type of sedation or use of paralytics.

What does it mean?

  • Among patients with cardiac arrest secondary to non-shockable rhythm, therapeutic hypothermia resulted in a higher rate of survival with favorable neurologic outcome compared to targeted normothermia.

  • This study provided support to using hypothermia in cardiac arrest patients secondary to asystole or PEA rhythm.


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