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Post–Cardiac Arrest Cooling — Colder Is Not Better

November 20, 2013

Post–Cardiac Arrest Cooling — Colder Is Not Better

  1. Ali S. Raja, MD, MBA, MPH, FACEP

Patients cooled to 33°C fared no better than those cooled to 36°C, but about half of each group survived.

  1. Ali S. Raja, MD, MBA, MPH, FACEP

Current guidelines recommend therapeutic hypothermia as a cornerstone of management for patients who remain unconscious after cardiac arrest, as it has been demonstrated to reduce mortality and improve neurologic function. However, the optimal target temperature (typically between 32°C and 35°C) has been unclear. Researchers randomized 950 patients in 36 European and Australian intensive care units to target temperatures of either 33°C or 36°C, to determine which might be more effective.

Of 939 patients included in the primary intention-to-treat analysis, 460 had died by the end of the trial (mean follow-up, 256 days). All-cause mortality was similar in the 33°C and 36°C groups (50% and 48%), as was the composite secondary outcome of death or poor neurologic function at 180 days (54% and 52%, respectively). Rates of serious adverse events also were similar in the two groups (93% and 90%).

Comment

This eye-opening and well-performed study convincingly argues against more-aggressive cooling after cardiac arrest. 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.

  • Disclosures for Ali S. Raja, MD, MBA, MPH, FACEP at time of publication Consultant / Advisory board Diagnotion, LLC Speaker's bureau Airway Management Education Center Grant / research support NHLBI; Brigham and Women’s Hospital Eleanor and Miles Shore Award; Harvard Medical School Milton Foundation; DHHS/CMS; NIBIB Editorial boards Western Journal of Emergency Medicine Leadership positions in professional societies Society for Academic Emergency Medicine; Brigham and Women’s Physician Organization

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