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01.12.2014 | Seven-Day Profile Publication

Impact of intra-arrest therapeutic hypothermia in outcomes of prehospital cardiac arrest: a randomized controlled trial

verfasst von: Guillaume Debaty, Maxime Maignan, Dominique Savary, François-xavier Koch, Stéphane Ruckly, Michel Durand, Julien Picard, Christophe Escallier, Renaud Chouquer, Charles Santre, Clemence Minet, Dorra Guergour, Laure Hammer, Hélène Bouvaist, Loic Belle, Christophe Adrie, Jean-François Payen, Françoise Carpentier, Pierre-Yves Gueugniaud, Vincent Danel, Jean-François Timsit

Erschienen in: Intensive Care Medicine | Ausgabe 12/2014

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Abstract

Purpose

Mild therapeutic hypothermia (TH) is recommended as soon as possible after the return of spontaneous circulation to improve outcomes after out-of-hospital cardiac arrest (OHCA). Preclinical data suggest that the benefit of TH could be increased if treatment is started during cardiac arrest. We aimed to study the impact of intra-arrest therapeutic hypothermia (IATH) on neurological injury and inflammation following OHCA.

Methods

We conducted a 1:1 randomized, multicenter study in three prehospital emergency medical services and four critical care units in France. OHCA patients, irrespective of the initial rhythm, received either an infusion of cold saline and external cooling during cardiac arrest (IATH group) or TH started after hospital admission (hospital-cooling group). The primary endpoint was neuron-specific enolase (NSE) serum concentrations at 24 h. Secondary endpoints included IL-6, IL-8, and IL-10 concentrations, and clinical outcome.

Results

Of the 245 patients included, 123 were analyzed in the IATH group and 122 in the hospital-cooling group. IATH decreased time to reach temperature ≤34 °C by 75 min (95 % CI: 4; 269). The rate of patients admitted alive to hospital was not different between groups [IATH n = 41 (33 %) vs. hospital cooling n = 36 (30 %); p = 0.51]. Levels of NSE and inflammatory biomarkers were not different between groups [median NSE at 24 h: IATH 96.7 μg/l (IQR: 49.9–142.8) vs. hospital cooling 97.6 μg/l (IQR: 74.3–142.4), p = 0.64]. No difference in survival and cerebral performance were found at 1 month.

Conclusions

IATH did not affect biological markers of inflammation or brain damage or clinical outcome.

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Titel: Impact of intra-arrest therapeutic hypothermia in outcomes of prehospital cardiac arrest: a randomized controlled trial
verfasst von: Guillaume Debaty
Maxime Maignan
Dominique Savary
François-xavier Koch
Stéphane Ruckly
Michel Durand
Julien Picard
Christophe Escallier
Renaud Chouquer
Charles Santre
Clemence Minet
Dorra Guergour
Laure Hammer
Hélène Bouvaist
Loic Belle
Christophe Adrie
Jean-François Payen
Françoise Carpentier
Pierre-Yves Gueugniaud
Vincent Danel
Jean-François Timsit
Publikationsdatum: 01.12.2014
Verlag: Springer Berlin Heidelberg
Erschienen in: Intensive Care Medicine / Ausgabe 12/2014
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-014-3519-x

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Impact of intra-arrest therapeutic hypothermia in outcomes of prehospital cardiac arrest: a randomized controlled trial

Abstract

Purpose

Methods

Results

Conclusions

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Springer Medizin

Abstract

Purpose

Methods

Results

Conclusions

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