Mild Therapeutic Hypothermia to Improve the Neurologic Outcome after Cardiac Arrest

50 Studies Every Intensivist Should Know ◽

10.1093/med/9780190467654.003.0001 ◽

2018 ◽

pp. 3-8

Author(s):

Ala Nozari

Keyword(s):

Cardiac Arrest ◽

Therapeutic Hypothermia ◽

Standard Care ◽

Important Variable ◽

Mild Therapeutic Hypothermia ◽

Target Temperature ◽

Neurologic Recovery ◽

Neurologic Outcomes ◽

Study Intervention

This chapter provides a summary of the landmark study known as the HACA Trial. Does mild therapeutic hypothermia improve neurologic outcomes compared with standard care normothermia in patients surviving ventricular fibrillation or pulseless ventricular tachycardic arrest? Starting with that question, it describes the basics of the study, including funding, study location, who was studied, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. Among the results, the preponderance of data suggests that temperature is an important variable for neurologic recovery after cardiac arrest. Guidelines suggest maintaining a target temperature between 32ºC and 36ºC for at least 24 hours after achieving target temperature. The chapter briefly reviews other relevant studies and information, discusses implications, and concludes with a relevant clinical case.

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Abstract 158: Association Between Initial Body Temperature and Neurologic Outcomes of Out-Of-Hospital Cardiac Arrest Undergoing Targeted Temperature Management

Circulation ◽

10.1161/circ.140.suppl_2.158 ◽

2019 ◽

Vol 140 (Suppl_2) ◽

Author(s):

Jong Hwan Kim ◽

Jeong Ho Park ◽

Sun Young Lee ◽

Sang Do Shin ◽

Jieun Pak ◽

...

Keyword(s):

Cardiac Arrest ◽

Body Temperature ◽

Spontaneous Circulation ◽

Targeted Temperature Management ◽

Temperature Management ◽

Target Temperature ◽

Multivariable Logistic Regression Model ◽

Neurologic Recovery ◽

Neurologic Outcomes ◽

Hospital Cardiac Arrest

Objectives: Targeted temperature management (TTM) is the core post-resuscitation care to minimize neurologic deficit after out-of-hospital cardiac arrest (OHCA). Uncontrolled body temperature of patients may reflect the thermoregulation ability which can be associated with neurologic damage during arrest. The aim of this study was to investigate the association between initial body temperature (BT) and neurologic outcomes in OHCA patients who underwent TTM. Methods: We used nationwide OHCA database from January 2016 to December 2017. Adult OHCA patients with presumed cardiac etiology who underwent TTM after return-of-spontaneous circulation (ROSC) were included. The main exposure was a BT at initiation of TTM which was categorized into 3 groups: low (-35.5°c), middle(35.6°c-37.4°c), and high BT (37.5°c-). The primary outcome was good neurologic outcome (cerebral performance categories (CPC) 1 or 2). Adjusted ratios (AORs) and 95% confidence intervals (CIs) were estimated to evaluate association between initial BT of TTM and outcome in multivariable logistic regression model. Stratified subgroup analyses were according to the target temperature of TTM (hypothermia vs normothermia). Results: Of a total of 744 patients, 208 (28.0%) patients were low initial BT group and 471 (63.3%) patients were normal initial BT group and 65 (8.7%) patients were high initial BT group. Good neurological recovery rate was 13.9% in low initial BT group, 41.8% in middle initial BT group and 36.9% in high initial BT group. The adjusted odds ratios for good neurologic recovery were 0.281 (95% confidence interval [CI] 0.17-0.47) in low BT group and 0.65 (95% CI 0.34-1.27) in high BT group compared with normal initial BT group. Similar results were also found regardless of target temperature of TTM. Conclusion: Low initial BT of TTM was associated with unfavorable neurologic recovery for OHCA patients who underwent TTM after ROSC.

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eCPR Combined With Therapeutic Hypothermia Could Improve Survival and Neurologic Outcomes for Patients With Cardiac Arrest: A Meta-Analysis

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.703567 ◽

2021 ◽

Vol 8 ◽

Author(s):

Jingwei Duan ◽

Qingbian Ma ◽

Changju Zhu ◽

Yuanchao Shi ◽

Baomin Duan

Keyword(s):

Cardiac Arrest ◽

Therapeutic Hypothermia ◽

Web Of Science ◽

Meta Analysis ◽

Short Term ◽

Risk Of Bleeding ◽

Neurologic Outcomes ◽

Online Databases ◽

Meta Analyses

Background: Extracorporeal membrane oxygenation with CPR (eCPR) or therapeutic hypothermia (TH) seems to be a very effective CPR strategy to save patients with cardiac arrest (CA). Furthermore, the subsequent post-CA neurologic outcomes have become the focus. Therefore, there is an urgent need to find a way to improve survival and neurologic outcomes for CA.Objective: We conducted this meta-analysis to find a more suitable CPR strategy for patients with CA.Method: We searched four online databases (PubMed, Embase, CENTRAL, and Web of Science). From an initial 1,436 articles, 23 studies were eligible into this meta-analysis, including a total of 2,035 patients.Results: eCPR combined with TH significantly improved the short-term (at discharge or 28 days) survival [OR = 2.27, 95% CIs (1.60–3.23), p < 0.00001] and neurologic outcomes [OR = 2.60, 95% CIs (1.92–3.52), p < 0.00001). At 3 months of follow-up, the results of survival [OR = 3.36, 95% CIs (1.65–6.85), p < 0.0008] and favorable neurologic outcomes [OR = 3.02, 95% CIs (1.38–6.63), p < 0.006] were the same as above. Furthermore, there was no difference in any bleeding needed intervention [OR = 1.33, 95% CIs (0.09–1.96), p = 0.16] between two groups.Conclusions: From this meta-analysis, we found that eCPR combined with TH might be a more suitable CPR strategy for patients with CA in improving survival and neurologic outcomes, and eCPR with TH did not increase the risk of bleeding. Furthermore, single-arm meta-analyses showed a plausible way of temperature and occasion of TH.

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