Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia.
BACKGROUND
Cardiac arrest outside the hospital is common and has a poor outcome. Studies in laboratory animals suggest that hypothermia induced shortly after the restoration of spontaneous circulation may improve neurologic outcome, but there have been no conclusive studies in humans. In a randomized, controlled trial, we compared the effects of moderate hypothermia and normothermia in patients who remained unconscious after resuscitation from out-of-hospital cardiac arrest.


METHODS
The study subjects were 77 patients who were randomly assigned to treatment with hypothermia (with the core body temperature reduced to 33 degrees C within 2 hours after the return of spontaneous circulation and maintained at that temperature for 12 hours) or normothermia. The primary outcome measure was survival to hospital discharge with sufficiently good neurologic function to be discharged to home or to a rehabilitation facility.


RESULTS
The demographic characteristics of the patients were similar in the hypothermia and normothermia groups. Twenty-one of the 43 patients treated with hypothermia (49 percent) survived and had a good outcome--that is, they were discharged home or to a rehabilitation facility--as compared with 9 of the 34 treated with normothermia (26 percent, P=0.046). After adjustment for base-line differences in age and time from collapse to the return of spontaneous circulation, the odds ratio for a good outcome with hypothermia as compared with normothermia was 5.25 (95 percent confidence interval, 1.47 to 18.76; P=0.011). Hypothermia was associated with a lower cardiac index, higher systemic vascular resistance, and hyperglycemia. There was no difference in the frequency of adverse events.


CONCLUSIONS
Our preliminary observations suggest that treatment with moderate hypothermia appears to improve outcomes in patients with coma after resuscitation from out-of-hospital cardiac arrest.
Bernard
Stephen A
SA
Intensive Care Unit, Dandenong Hospital, Dandenong, Australia. s.bernard@southernhealth.org.au
Gray
Timothy W
TW
Buist
Michael D
MD
Jones
Bruce M
BM
Silvester
William
W
Gutteridge
Geoff
G
Smith
Karen
K
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002302:Cardiac Output; D016887:Cardiopulmonary Resuscitation; D003128:Coma / Q000209:etiology / Q000628:therapy; D004632:Emergency Medical Services; D005260:Female; D006323:Heart Arrest / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D006943:Hyperglycemia / Q000209:etiology; D007036:Hypothermia, Induced / Q000009:adverse effects; D020925:Hypoxia-Ischemia, Brain / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011446:Prospective Studies; D015427:Reperfusion Injury / Q000517:prevention & control; D016896:Treatment Outcome; D014655:Vascular Resistance; D014693:Ventricular Fibrillation / Q000150:complications / Q000628:therapy