Impact of intra-arrest therapeutic hypothermia in outcomes of prehospital cardiac arrest

a randomized controlled trial

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 & 1 others Jean François Timsit

Research output: Contribution to journalArticle

Abstract

Conclusions: IATH did not affect biological markers of inflammation or brain damage or 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.

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.

Original languageEnglish (US)
Pages (from-to)1832-1842
Number of pages11
JournalIntensive Care Medicine
Volume40
Issue number12
DOIs
StatePublished - Nov 21 2014
Externally publishedYes

Fingerprint

Induced Hypothermia
Heart Arrest
Randomized Controlled Trials
Out-of-Hospital Cardiac Arrest
Phosphopyruvate Hydratase
Biomarkers
Emergency Medical Services
Encephalitis
Critical Care
Interleukin-8
Interleukin-10
Multicenter Studies
France
Interleukin-6
Inflammation

Keywords

  • Cardiac arrest
  • Cardiopulmonary resuscitation
  • Post-cardiac arrest syndrome
  • Resuscitation
  • Therapeutic hypothermia

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Medicine(all)

Cite this

Debaty, G., Maignan, M., Savary, D., Koch, F. X., Ruckly, S., Durand, M., ... Timsit, J. F. (2014). Impact of intra-arrest therapeutic hypothermia in outcomes of prehospital cardiac arrest: a randomized controlled trial. Intensive Care Medicine, 40(12), 1832-1842. https://doi.org/10.1007/s00134-014-3519-x

Impact of intra-arrest therapeutic hypothermia in outcomes of prehospital cardiac arrest : a randomized controlled trial. / Debaty, Guillaume; Maignan, Maxime; Savary, Dominique; Koch, François xavier; Ruckly, Stéphane; Durand, Michel; Picard, Julien; Escallier, Christophe; Chouquer, Renaud; Santre, Charles; Minet, Clemence; Guergour, Dorra; Hammer, Laure; Bouvaist, Hélène; Belle, Loic; Adrie, Christophe; Payen, Jean François; Carpentier, Françoise; Gueugniaud, Pierre Yves; Danel, Vincent; Timsit, Jean François.

In: Intensive Care Medicine, Vol. 40, No. 12, 21.11.2014, p. 1832-1842.

Research output: Contribution to journalArticle

Debaty, G, Maignan, M, Savary, D, Koch, FX, Ruckly, S, Durand, M, Picard, J, Escallier, C, Chouquer, R, Santre, C, Minet, C, Guergour, D, Hammer, L, Bouvaist, H, Belle, L, Adrie, C, Payen, JF, Carpentier, F, Gueugniaud, PY, Danel, V & Timsit, JF 2014, 'Impact of intra-arrest therapeutic hypothermia in outcomes of prehospital cardiac arrest: a randomized controlled trial', Intensive Care Medicine, vol. 40, no. 12, pp. 1832-1842. https://doi.org/10.1007/s00134-014-3519-x
Debaty, Guillaume ; Maignan, Maxime ; Savary, Dominique ; Koch, François xavier ; Ruckly, Stéphane ; Durand, Michel ; Picard, Julien ; Escallier, Christophe ; Chouquer, Renaud ; Santre, Charles ; Minet, Clemence ; Guergour, Dorra ; Hammer, Laure ; Bouvaist, Hélène ; Belle, Loic ; Adrie, Christophe ; Payen, Jean François ; Carpentier, Françoise ; Gueugniaud, Pierre Yves ; Danel, Vincent ; Timsit, Jean François. / Impact of intra-arrest therapeutic hypothermia in outcomes of prehospital cardiac arrest : a randomized controlled trial. In: Intensive Care Medicine. 2014 ; Vol. 40, No. 12. pp. 1832-1842.
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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

PY - 2014/11/21

Y1 - 2014/11/21

N2 - Conclusions: IATH did not affect biological markers of inflammation or brain damage or 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.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.

AB - Conclusions: IATH did not affect biological markers of inflammation or brain damage or 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.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.

KW - Cardiac arrest

KW - Cardiopulmonary resuscitation

KW - Post-cardiac arrest syndrome

KW - Resuscitation

KW - Therapeutic hypothermia

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