Publication
Mild therapeutic hypothermia improves outcomes compared with normothermia in cardiac-arrest patients--a retrospective chart review
Journal Paper/Review - Aug 1, 2012
Hörburger David, Wallmüller Christian, Weiser Christoph, Stratil Peter, Stöckl Mathias, Schober Andreas, Uray Thomas, Krizanac Danica, Herkner Harald, Sterz Fritz, Testori Christoph, Holzer Michael
Units
PubMed
Doi
Citation
Type
Journal
Publication Date
Issn Electronic
Pages
Brief description/objective
OBJECTIVE
Studies showing the effectiveness of therapeutic hypothermia (32-34°C) in postcardiac arrest patients have been criticized because of patients with elevated body temperature (>37.5°C) in the noncooled control group. Thus, the effects of spontaneous normothermia (<37.5°C) compared with mild therapeutic hypothermia were studied.
DESIGN
Retrospective chart review from 1991 to 2010.
PATIENTS
Witnessed out-of-hospital arrest, presumed to be of cardiac origin, aged 18 to 80 yrs and with a Glassgow Coma Scale score of <8 at admission.
INTERVENTIONS
Patients with sustained restoration of spontaneous circulation who did not receive therapeutic hypothermia and never exceeded 37.5°C during the 36 hrs postcardiac arrest were compared with patients who received mild therapeutic hypothermia.
MEASUREMENTS AND MAIN RESULTS
The primary end point was a favorable neurological outcome, defined as Cerebral Performance Categories 1 or 2; the secondary end point was overall survival to 180 days. Significantly more patients in the hypothermia group had Cerebral Performance Categories 1 or 2 (hypothermia: 256 of 467 [55%] vs. normothermia: 69 of 165 [42%]) and survived for >180 days (hypothermia: 315 of 467 [67%] vs. normothermia: 79 of 165 [48%]). The propensity score adjusted risk ratio for good neurological outcome of patients undergoing hypothermia treatment was 1.37 (confidence interval 1.09-1.72, p≤.01) and for dying within 180 days was 0.57 (confidence interval 0.44-0.73, p≤.01) compared to normothermia.
CONCLUSIONS
Therapeutic hypothermia is associated with significantly improved neurological outcome and 180-day survival compared to spontaneous normothermia in cardiac-arrest patients.