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

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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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Acknowledgments

We thank the emergency physicians, nurses and ambulances crew from Grenoble University Hospital, Annecy Hospital and Voiron Hospital. We also thank the intensive care physicians and nurses of the different intensives care units of those hospitals for their participation in this study.

Conflicts of interest

Funding for the study was provided by a grant from the French Society of Emergency Medicine (SFMU). The SFMU had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. The authors declare no conflicts of interest.

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Correspondence to Guillaume Debaty.

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134_2014_3519_MOESM1_ESM.pptx

Figure S1 (electronic supplement): 1-month survival according to initial rhythm. IATH: Intra-arrest therapeutic Hypothermia; VF/VT: Ventricular Fibrillation/Ventricular Tachycardia, PEA: Pulseless electrical activity (PPTX 45 kb)

134_2014_3519_MOESM2_ESM.pdf

Figure S2 (electronic supplement): Probability of Survival. Shown are Kaplan–Meier estimates of the probability of survival for patients assigned to Intra arrest therapeutic hypothermia or hospital cooling group within the first 30 days after randomization. The p value was calculated with logrank analysis. (PDF 5 kb)

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Debaty, G., Maignan, M., Savary, D. et al. Impact of intra-arrest therapeutic hypothermia in outcomes of prehospital cardiac arrest: a randomized controlled trial. Intensive Care Med 40, 1832–1842 (2014). https://doi.org/10.1007/s00134-014-3519-x

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  • DOI: https://doi.org/10.1007/s00134-014-3519-x

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