A Comparison of Cooling Techniques to Treat Cardiac Arrest Patients with Hypothermia

Caulfield, Anna Finley; Rachabattula, Shylaja; Eyngorn, Irina; Hamilton, Scott; Kalimuthu, Rajalakshmi; Hsia, Amie W.; Lansberg, Maarten G.; Venkatasubramanian, Chitra; Baumann, JJ; Buckwalter, Marion S.; Kumar, Monisha A.; Castle, James; Wijman, Christine A.C.

doi:10.4061/2011/690506

Cited by 25 publications

(25 citation statements)

References 18 publications

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“…8,[11][12][13][14]24,[33][34][35] In our study, we failed to demonstrate a clear clinical superiority of the endovascular cooling versus basic external cooling for the management of OHCA patients, despite important differences in the induction and maintenance phases of TTM. According to the literature, the level of evidence to assess the superiority of intravascular cooling on the prognosis after CA remains poor.…”

Section: Downloaded From July 21 2015mentioning

confidence: 38%

Endovascular Versus External Targeted Temperature Management for Patients With Out-of-Hospital Cardiac Arrest

et al. 2015

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Background— Targeted temperature management is recommended after out-of-hospital cardiac arrest. Whether advanced internal cooling is superior to basic external cooling remains unknown. The aim of this multicenter, controlled trial was to evaluate the benefit of endovascular versus basic surface cooling. Methods and Results— Inclusion criteria were the following: age of 18 to 79 years, out-of-hospital cardiac arrest related to a presumed cardiac cause, time to return of spontaneous circulation <60 minutes, delay between return of spontaneous circulation and inclusion <240 minutes, and unconscious patient after return of spontaneous circulation and before the start of cooling. Exclusion criteria were terminal disease, pregnancy, known coagulopathy, uncontrolled bleeding, temperature on admission <30°C, in-hospital cardiac arrest, immediate need for extracorporeal life support or hemodialysis. Patients were randomized between 2 cooling strategies: endovascular femoral devices (Icy catheter, Coolgard, Zoll, formerly Alsius; n=203) or basic external cooling using fans, a homemade tent, and ice packs (n=197). The primary end point, that is, favorable outcome evaluated by survival without major neurological damage (Cerebral Performance Categories 1–2) at day 28, was not significantly different between groups (odds ratio, 1.41; 95% confidence interval, 0.93–2.16; P =0.107). Improvement in favorable outcome at day 90 in favor of the endovascular group did not reach significance (odds ratio, 1.51; 95% confidence interval, 0.96–2.35; P =0.07). Time to target temperature (33°C) was significantly shorter and target hypothermia was more strictly maintained in the endovascular than in the surface group ( P <0.001). Minor side effects directly related to the cooling method were observed more frequently in the endovascular group ( P =0.009). Conclusion— Despite better hypothermia induction and maintenance, endovascular cooling was not significantly superior to basic external cooling in terms of favorable outcome. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00392639.

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Section: Downloaded From July 21 2015mentioning

confidence: 38%

Endovascular Versus External Targeted Temperature Management for Patients With Out-of-Hospital Cardiac Arrest

et al. 2015

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“…Endovascular cooling and other surface automatic devices have proved to be more accurate methods for temperature regulation than conventional surface cooling techniques. 12 This has generated the need to determine the optimum level of cooling in this situation, particularly when there is a possibility of maintaining the target temperature at a stable level within a narrow margin. At the time when this pilot study was designed, no data were available in humans that would aid in choosing between 32°and 34°C.…”

Section: Lopez-de-sa Et Al Two Hypothermia Levels Post Cardiac Arrestmentioning

confidence: 99%

Hypothermia in Comatose Survivors From Out-of-Hospital Cardiac Arrest

et al. 2012

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Background— It is recommended that comatose survivors of out-of-hospital cardiac arrest should be cooled to 32° to 34°C for 12 to 24 hours. However, the optimal level of cooling is unknown. The aim of this pilot study was to obtain initial data on the effect of different levels of hypothermia. We hypothesized that deeper temperatures will be associated with better survival and neurological outcome. Methods and Results— Patients were eligible if they had a witnessed out-of-hospital cardiac arrest from March 2008 to August 2011. Target temperature was randomly assigned to 32°C or 34°C. Enrollment was stratified on the basis of the initial rhythm as shockable or asystole. The target temperature was maintained during 24 hours followed by 12 to 24 hours of controlled rewarming. The primary outcome was survival free from severe dependence (Barthel Index score ≥60 points) at 6 months. Thirty-six patients were enrolled in the trial (26 shockable rhythm, 10 asystole), with 18 assigned to 34°C and 18 to 32°C. Eight of 18 patients in the 32°C group (44.4%) met the primary end point compared with 2 of 18 in the 34°C group (11.1%) (log-rank P =0.12). All patients whose initial rhythm was asystole died before 6 months in both groups. Eight of 13 patients with initial shockable rhythm assigned to 32°C (61.5%) were alive free from severe dependence at 6 months compared with 2 of 13 (15.4%) assigned to 34°C (log-rank P =0.029). The incidence of complications was similar in both groups except for the incidence of clinical seizures, which was lower (1 versus 11; P =0.0002) in patients assigned to 32°C compared with 34°C. On the contrary, there was a trend toward a higher incidence of bradycardia (7 versus 2; P =0.054) in patients assigned to 32°C. Although potassium levels decreased to a greater extent in patients assigned to 32°C, the incidence of hypokalemia was similar in both groups. Conclusions— The findings of this pilot trial suggest that a lower cooling level may be associated with a better outcome in patients surviving out-of-hospital cardiac arrest secondary to a shockable rhythm. The benefits observed here merit further investigation in a larger trial in out-of-hospital cardiac arrest patients with different presenting rhythms. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT01155622.

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“…Due to the difficulty of modifying the model for two environmental parameters in the same simulation, the water bath was included in the individual analysis considering only cooling. Furthermore, this technique was proven to be less effective than the others [43], for the same objective temperature this technique achieved higher hypothalamus temperature as in Fig. 10(a).…”

Section: Comparison Of Techniquesmentioning

confidence: 50%