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, M.; Picard, J.; Escallier, Christophe; Chouquer, Renaud; Santré, Charles; Minet, Clémence; Guergour, Dorra; Hammer, Laure; Bouvaist, Hélène; Belle, Loïc; Adrie, Christophe; Payen, Jean François; Carpentier, F.; Gueugniaud, P. Y.; Danel, Vincent; Timsit, Jean François

doi:10.1007/s00134-014-3519-x

Cited by 94 publications

(74 citation statements)

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“…These high levels indicate that neurological injury in this patient population was already extensive and that therapeutic hypothermia would be of no use. Debaty et al [1] report the survival rate at 1 month to be 7 % in the IATH group versus 5 % in hospital cooling group, which is quite low compared to that reported in previous hypothermia trials. Thus, we suggest that the results of this study cannot be generalized as the results of this this trial pertain to a specific patient population which already has a poor prognosis.…”

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confidence: 70%

“…Dear Editor, We read the recent article by Debaty et al [1] with great interest. The methodology used in this trial is of high quality, but the participants were a non-selected study population, of which 80 % were patients with a nonshockable rhythm and, therefore, barely 20 % had a shockable rhythm.…”

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confidence: 99%

“…In a recent study by Calderon et al [5], NSE values of [49.5 ng/mL at 48 h and [10.59 ng/ mL at 72 h predicted mortality. In the study by Debaty et al [1], the patients had median NSE levels of 96.7 lg/ml in the intra-arrest therapeutic hypothermia group (IATH) at 24 h, which can be considered as quite high levels. These high levels indicate that neurological injury in this patient population was already extensive and that therapeutic hypothermia would be of no use.…”

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confidence: 99%

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Comment on Debaty et al.: Impact of intra-arrest therapeutic hypothermia in outcomes of prehospital cardiac arrest: a randomized controlled trial

Saigal

Sharma

2014

Intensive Care Med

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Comment on Debaty et al.: Impact of intra-arrest therapeutic hypothermia in outcomes of prehospital cardiac arrest: a randomized controlled trial

Saigal

Sharma

2014

Intensive Care Med

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“…The final Class I study 28 included 245 patients with any rhythm after OHCA. Patients were randomized to receive either intra-arrest TH with external cooling and an infusion of cold saline or no prehospital cooling.…”

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confidence: 99%

Practice guideline summary: Reducing brain injury following cardiopulmonary resuscitation

et al. 2017

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Objective: To assess the evidence and make evidence-based recommendations for acute interventions to reduce brain injury in adult patients who are comatose after successful cardiopulmonary resuscitation.Methods: Published literature from 1966 to August 29, 2016, was reviewed with evidencebased classification of relevant articles. Results and recommendations:For patients who are comatose in whom the initial cardiac rhythm is either pulseless ventricular tachycardia (VT) or ventricular fibrillation (VF) after out-of-hospital cardiac arrest (OHCA), therapeutic hypothermia (TH; 32-348C for 24 hours) is highly likely to be effective in improving functional neurologic outcome and survival compared with non-TH and should be offered (Level A). For patients who are comatose in whom the initial cardiac rhythm is either VT/VF or asystole/pulseless electrical activity (PEA) after OHCA, targeted temperature management (368C for 24 hours, followed by 8 hours of rewarming to 378C, and temperature maintenance below 37.58C until 72 hours) is likely as effective as TH and is an acceptable alternative (Level B). For patients who are comatose with an initial rhythm of PEA/asystole, TH possibly improves survival and functional neurologic outcome at discharge vs standard care and may be offered (Level C). Prehospital cooling as an adjunct to TH is highly likely to be ineffective in further improving neurologic outcome and survival and should not be offered (Level A). Other pharmacologic and nonpharmacologic strategies (applied with or without concomitant TH) are also reviewed. Neurology ® 2017;88:2141-2149 GLOSSARY AAN 5 American Academy of Neurology; AE 5 adverse event; CI 5 confidence interval; CPC 5 Cerebral Performance Category; CPR 5 cardiopulmonary resuscitation; ECMO 5 extracorporeal membrane oxygenation; HF 5 hemofiltration; IHCA 5 in-hospital cardiac arrest; OHCA 5 out-of-hospital cardiac arrest; PEA 5 pulseless electrical activity; RD 5 risk difference; ROSC 5 return of spontaneous circulation; TH 5 therapeutic hypothermia; TTM 5 targeted temperature management; VT 5 ventricular tachycardia; VF 5 ventricular fibrillation.Outcomes for patients after nontraumatic cardiac arrest are dismal. Only 6%-9.6% of all patients with out-of-hospital cardiac arrest (OHCA) survive to hospital discharge, 1,2 and an estimated 22.3% of patients with in-hospital cardiac arrest (IHCA) survive to hospital discharge.3 Brain injury related to cardiac arrest is a major determinant of mortality and disability.

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“…Large cohorts, multinational observational studies [5], randomised clinical trials [6], systematic reviews [7] and meta-analyses [8] guidelines. Particular attention to ethical issues is another important qualifying element of our editorial policy.…”

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The ten wishes and hopes of the deputy editors of Intensive Care Medicine

2016

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Impact of intra-arrest therapeutic hypothermia in outcomes of prehospital cardiac arrest: a randomized controlled trial

Abstract: IATH did not affect biological markers of inflammation or brain damage or clinical outcome.

Cited by 94 publications

References 40 publications

Comment on Debaty et al.: Impact of intra-arrest therapeutic hypothermia in outcomes of prehospital cardiac arrest: a randomized controlled trial

Comment on Debaty et al.: Impact of intra-arrest therapeutic hypothermia in outcomes of prehospital cardiac arrest: a randomized controlled trial

Practice guideline summary: Reducing brain injury following cardiopulmonary resuscitation

The ten wishes and hopes of the deputy editors of Intensive Care Medicine

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