New study: intra-arrest therapeutic hypothermia

medicsb

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Intensive Care Med. 2014 Oct 28. [Epub ahead of print]
Impact of intra-arrest therapeutic hypothermia in outcomes of prehospital cardiac arrest: a randomized controlled trial.
Debaty G1, 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.
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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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Critical Crazy
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good stuff

are you doing 36 or 33 at your facility?
 

chaz90

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Cool post, thank you!
 

VFlutter

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Do you guys use Arctic Sun?
 

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medicsb

Forum Asst. Chief
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good stuff

are you doing 36 or 33 at your facility?

I'm not sure. I haven't done an adult ICU rotation yet and I've only been in the adult ED for a little over one month since July (had anesthesia and pediatric off service rotations at other hospitals). The PICU I rotated through cooled to 35 C, if I recall correctly (we did cool one kid, but I wasn't caring for him). The main ED I work gets lots of cardiac arrests, but the survival is dismal. I don't think I've seen one survive to ICU, partly because EMS here is all about "load and go" and all the ones I've worked have been PEA or asystole as primary rhythm (funny, now that I think of it, but I've seen more trauma arrests at this point). Doesn't help that the surrounding communities are very poor with limited healthcare access, thus many many comorbities and virtually nobody getting bystander CPR or AED.

The TTM trial burned through the EM community, but I'm not sure how well it has permeated into the intensivist crowd. Hopefully, I'll remember to ask what the target temp is at my place (meant to ask last night).
 
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