Category: Critical Care
Keywords: OHCA, hypothermia, normothermia (PubMed Search)
Posted: 6/29/2021 by Quincy Tran, MD
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Settings: International multicenter trials; 1:1 randomization, blinded assessment of outcomes.
Patients: adults with witnessed OHCA, regardless of initial rhythm. Patients had more than 20 minutes of CPR. Eligible patients were unconscious, not able to follow command, no verbal responses to painful stimuli.
Intervention: hypothermia to target of 33C for 28 hours, then rewarming at rate of 1/3C every hour until 37C.
Comparison: maintaining temperature at 37.5C or less. Cooling if body temperature reached 37.8C to 37.5C
Outcome: primary outcome was Any cause mortality at 6 months; secondary outcome was poor functional outcome at 6 months (modified Rankin Scale 4-6).
1. 930 hypothermia, mortality 465/925 (50%, RR 1.04, 95%CI 0.94-1.14); 488/881 (55%) had mRS 4-6 (RR 1.0, 95%CI 0.92-1.09).
2. 931 normothermia, mortality 446/925 (48%); 479/866 (55%) had mRS 4-6.
Normothermia in coma patients after OHCA did not lead to higher morality or worse neurologic outcomes.
Dankiewicz J, Cronberg T, Lilja G, Jakobsen JC, Levin H, Ullén S, Rylander C, Wise MP, Oddo M, Cariou A, B?lohlávek J, Hovdenes J, Saxena M, Kirkegaard H, Young PJ, Pelosi P, Storm C, Taccone FS, Joannidis M, Callaway C, Eastwood GM, Morgan MPG, Nordberg P, Erlinge D, Nichol AD, Chew MS, Hollenberg J, Thomas M, Bewley J, Sweet K, Grejs AM, Christensen S, Haenggi M, Levis A, Lundin A, Düring J, Schmidbauer S, Keeble TR, Karamasis GV, Schrag C, Faessler E, Smid O, Otáhal M, Maggiorini M, Wendel Garcia PD, Jaubert P, Cole JM, Solar M, Borgquist O, Leithner C, Abed-Maillard S, Navarra L, Annborn M, Undén J, Brunetti I, Awad A, McGuigan P, Bjørkholt Olsen R, Cassina T, Vignon P, Langeland H, Lange T, Friberg H, Nielsen N; TTM2 Trial Investigators. Hypothermia versus Normothermia after Out-of-Hospital Cardiac Arrest. N Engl J Med. 2021 Jun 17;384(24):2283-2294. doi: 10.1056/NEJMoa2100591. PMID: 34133859.
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