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Mild hypothermia treatment in patients resuscitated from non-shockable cardiac arrest
  1. Christian Storm1,
  2. Jens Nee1,
  3. Mattias Roser2,
  4. Achim Jörres1,
  5. Dietrich Hasper1
  1. 1Department of Nephrology and Medical Intensive Care, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
  2. 2Department of Cardiology, German Heart Centre Berlin, Berlin, Germany
  1. Correspondence to Dr Christian Storm, Department of Nephrology and Medical Intensive Care, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany; christian.storm{at}charite.de

Abstract

Objective Therapeutic hypothermia has proved effective in improving outcome in patients after cardiac arrest due to ventricular fibrillation (VF). The benefit in patients with non-VF cardiac arrest is still not defined.

Methods This prospective observational study was conducted in a university hospital setting with historical controls. Between 2002 and 2010 387 consecutive patients have been admitted to the intensive care unit (ICU) after cardiac arrest (control n=186; hypothermia n=201). Of those, in 175 patients the initial rhythm was identified as non-shockable (asystole, pulseless electrical activity) rhythm (control n=88; hypothermia n=87). Neurological outcome was assessed at ICU discharge according to the Pittsburgh cerebral performance category (CPC). A follow-up was completed for all patients after 90 days, a Kaplan–Meier analysis and Cox regression was performed.

Results Hypothermia treatment was not associated with significantly improved neurological outcome in patients resuscitated from non-VF cardiac arrest (CPC 1–2: hypothermia 27.59% vs control 18.20%, p=0.175). 90-Day Kaplan–Meier analysis revealed no significant benefit for the hypothermia group (log rank test p=0.82), and Cox regression showed no statistically significant improvement.

Conclusions In this cohort patients undergoing hypothermia treatment after non-shockable cardiac arrest do not benefit significantly concerning neurological outcome. Hypothermia treatment needs to be evaluated in a large multicentre trial of cardiac arrest patients found initially to be in non-shockable rhythms to clarify whether cooling may also be beneficial for other rhythms than VF.

  • Cardiac arrest
  • environmental medicine
  • hypothermia
  • non-shockable rhythm
  • resuscitation
  • therapeutic hypothermia

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Footnotes

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of the ethics committee of the Charité-Universitätsmedizin Berlin, Germany.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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