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Chris Cairns
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Therapeutic Hypothermia - Post OOHCA
Principal investigator: Dr Chris Cairns Investigating the use of therapeutic hypothermia following out-of-hospital cardiac arrest. Current State: Complete. Published December 2004.
Therapeutic Hypothermia After Out-of-Hospital Cardiac Arrest
Chris JS Cairns on behalf of the SICS EBM group Consultant, Anaesthesia & Intensive Care, Stirling Royal Infirmary, Livilands, Stirling, FK8 2AU Correspondence: Chris.Cairns@btinternet.com Citation: EBM Reviews. Scottish Intensive Care Society EBM Group. Cairns CJS. Therapeutic Hypothermia After Out-of-Hospital Cardiac Arrest. 2004 Background: In Europe it is estimated that there are approximately 375,00 cardiac arrests per annum. With traditionally poor outcomes, cardiac arrest is therefore a major cause of mortality and morbidity. Interest in the use of therapeutic hypothermia in these patients is developing rapidly. Objectives: To critically appraise the evidence for the use of therapeutic hypothermia after out-of-hospital cardiac arrest. Search strategy: Hypothermia subheadings- therapy / drug therapy limited to prospective randomised trials or meta-analysis; human; AIM journals. Using Medline, Pubmed and manual searches of citations. Selection criteria: One reviewer (CC) selected studies for inclusion. One reviewer (CC) assessed trial quality and independently extracted the data and two others (BC and PA) independently checked the analysis. Only randomised, controlled trials (RCTs) and meta-analysis were included in the main results. Data collection and analysis: The literature search resulted in 3 RCTs, two of which were included in the final analysis [1,2] (one small feasibility study was excluded [3]). These accounted for a total of 213 patients. The published data was analyzed with the CATmaker™ software. The search found no meta-analysis . Therefore, data available for this intervention is very limited. Main results: The Hypothermia After Cardiac Arrest Study Group demonstrated that 24 hours of therapeutic hypothermia following a witnessed ventricular fibrillation (VF) or ventricular tachycardia (VT) arrest resulted in reduced mortality (NNT 7, 95% CI 4-40) and increased the number of survivors with a good neurological outcome (NNT 6, 95% CI 4-25) [1]. In a smaller study Bernard et al demonstrated that 12 hours of hypothermia following a VF arrest was associated with an increase in good neurological outcome (NNT 4, 95% CI 4-80) and a non-significant decrease in mortality. The use of therapeutic hypothermia was not associated with an increase in survivors with a poor neurological outcome. Reviewers conclusions: Grade A recommendation: After considering the inclusion and exclusion criteria of the published studies, patients admitted to hospital following an out-of-hospital cardiac arrest should be cooled to 32-34 C within 4 hours of the return of spontaneous cardiac output. This should be maintained for 24 hours, on the intensive care unit, at which time the patient should be slowly warmed to normothermia. This would be in keeping with the recommendations published by the International Advisory Committee on Resuscitation in 2003 [4]. Of the 375,000 cardiac arrests each year in Europe it is estimated that 30,000 (8%) would fulfill the study inclusion criteria. Adopting this technique may result in the prevention of 1200 to 7500 unfavourable neurological outcomes per year. Areas of further research: · To determine whether Therapeutic Hypothermia is of benefit following cardiac arrest due to causes other than VF or VT and in a wider spectrum of post-VF / VT patients.
Citations with links to CATs: 1. The Hypothermia After Cardiac Arrest Study Group. Mild therapeutic hypothermia to improve neurologic outcome after cardiac arrest. New England Journal of Medicine 2002;346:549-556. CAT. 2. Bernard SA, Gray TW, Buist MD, et al. Treatment of comatosed survivors of out-of-hospital cardiac arrest with induced hypothermia. New England Journal of Medicine 2002;346:557-563. CAT. 3. Zeiner A, Holzer M, Sterz F, et al. Mild resuscitative hypothermia to improve neurological outcome after cardiac arrest. A clinical feasibility trial. Hypothermia After Cardiac Arrest (HACA) Study Group. Stroke 2000;31:86-94.
Reviewed & Edited by PJDA & BC Printer Friendly Version© SICS EBM Group 2004
Citations with links to CATs: 1.
Printer Friendly Version Reviewed by PJDA & BC
© SICS EBM Group 2004
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