Article Citation: Holzer M, et al. “Mild Therapeutic Hypothermia to Improve the Neurologic Outcome After Cardiac Arrest”. The New England Journal of Medicine. 2002. 346(8):549-556.

What we already know about the topic: prelim studies demonstrated that lowering brain temp s/p cardiac arrest improves neurologic recovery.

Why this study is important: Hypoxemic brain injury is the most common cause of death in patients s/p cardiac arrest and lowering brain temperature reduces risk of neurologic injury.

Brief overview of the study:

  • Study design: multicenter, unblinded RCT in 9 centers in 5 European countries from 1996-2000 with intention to treat
  • N = 275
    • Hypothermia n = 137
    • Normothermia n = 138
  • Patients were randomly assigned to hypothermia and normothermia groups.
  • Hypothermia: target bladder temp 32-34 within 4h after ROSC with external cooling device and temp maintained for 24h from start of cooling followed by passive rewarming to temp > 36
  • Neurologic outcome assessed using Pittsburgh cerebral performance scale:

                             1: good recovery

                             2: moderate disability

                             3: severe disability

                            4: vegetative state

                            5: death

                           1&2 = favorable outcome.

Primary outcome: favorable neurologic outcome within 6 months: 55% (hypothermia) vs 39% (normothermia)

Limitations: it was a small trial where physician were not blinded to treatment assignments.

Take home points: in pts with VF or pulseless VT arrest, mild therapeutic hypothermia (32-34 degree celcius) improved neurologic outcomes and reduced mortality at 6 months.

PS:
TTM trial in 2013 found no difference between temp targets of 33 and 36 for all cause mortality or cognitive benefit.  So maybe avoiding hyperthermia is the key here? 

March 2024
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