Therapeutic hypothermia

Colder isn’t always better for post-cariac arrest patients

COLDER is not better in therapeutic hypothermia for unconscious patients after a cardiac arrest, according to a study.

To identify the most efficient target temperature between 32°C and 35°C, researchers made 939 patients from 36 European and Australian intensive care units undergo a primary intention-to-treat analysis.

At the end of the trial, 460 participants expired after a mean follow-up of 256 days. All-cause mortality was similar in the 33°C (50 percent) and 36°C groups (28 percent), as was the composite secondary outcome of death or poor neurologic function at 180 days (54 percent and 52 percent, respectively).

The rates of serious adverse events are similar in the two groups: 93 percent for the 33°C group, and 90 percent for the 36°C group.

Dr. Ali S. Raja of Jwatch.org noted that it is an “eye-opening and well-performed” study which argues against more-aggressive cooling after cardiac arrest, but active temperature regulations for these patients remain the same.

He added: “However, outcomes in both groups were reportedly better than historical outcomes without therapeutic hypothermia, and the underlying benefits of active temperature regulation in these patients remain unchanged.” Aencille Santos with a Jwatch.org report

VitalSigns Issue 58 Vol. 2, December 1-31, 2013