TY - JOUR
T1 - Impact of intra-arrest therapeutic hypothermia in outcomes of prehospital cardiac arrest
T2 - a randomized controlled trial
AU - Debaty, Guillaume
AU - Maignan, Maxime
AU - Savary, Dominique
AU - Koch, François xavier
AU - Ruckly, Stéphane
AU - Durand, Michel
AU - Picard, Julien
AU - Escallier, Christophe
AU - Chouquer, Renaud
AU - Santre, Charles
AU - Minet, Clemence
AU - Guergour, Dorra
AU - Hammer, Laure
AU - Bouvaist, Hélène
AU - Belle, Loic
AU - Adrie, Christophe
AU - Payen, Jean François
AU - Carpentier, Françoise
AU - Gueugniaud, Pierre Yves
AU - Danel, Vincent
AU - Timsit, Jean François
N1 - Funding Information:
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.
Publisher Copyright:
© 2014, Springer-Verlag Berlin Heidelberg and ESICM.
PY - 2014/11/21
Y1 - 2014/11/21
N2 - 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.
AB - 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.
KW - Cardiac arrest
KW - Cardiopulmonary resuscitation
KW - Post-cardiac arrest syndrome
KW - Resuscitation
KW - Therapeutic hypothermia
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U2 - 10.1007/s00134-014-3519-x
DO - 10.1007/s00134-014-3519-x
M3 - Article
C2 - 25348858
AN - SCOPUS:84918774880
SN - 0342-4642
VL - 40
SP - 1832
EP - 1842
JO - Intensive Care Medicine
JF - Intensive Care Medicine
IS - 12
ER -