Efficacy and safety of endovascular cooling after cardiac arrest: cohort study and Bayesian approach.
OBJECTIVE
Recently 2 randomized trials in comatose survivors of cardiac arrest documented that therapeutic hypothermia improved neurological recovery. The narrow inclusion criteria resulted in an international recommendation to cool only a restricted group of primary cardiac arrest survivors. In this retrospective cohort study we investigated the efficacy and safety of endovascular cooling in unselected survivors of cardiac arrest.


METHODS
Consecutive comatose survivors of cardiac arrest, who were either cooled for 24 hours to 33 degrees C with endovascular cooling or treated with standard postresuscitation therapy, were analyzed. Complication data were obtained by retrospective chart review.


RESULTS
Patients in the endovascular cooling group had 2-fold increased odds of survival (67/97 patients versus 466/941 patients; odds ratio 2.28, 95% CI, 1.45 to 3.57; P<0.001). After adjustment for baseline imbalances the odds ratio was 1.96 (95% CI, 1.19 to 3.23; P=0.008). When discounting the observational data in a Bayesian analysis by using a sceptical prior the posterior odds ratio was 1.61 (95% credible interval, 1.06 to 2.44). In the endovascular cooling group, 51/97 patients (53%) survived with favorable neurology as compared with 320/941 (34%) in the control group (odds ratio 2.15, 95% CI, 1.38 to 3.35; P=0.0003; adjusted odds ratio 2.56, 1.57 to 4.17). There was no difference in the rate of complications except for bradycardia.


CONCLUSIONS
Endovascular cooling improved survival and short-term neurological recovery compared with standard treatment in comatose adult survivors of cardiac arrest. Temperature control was effective and safe with this device.
Holzer
Michael
M
Department of Emergency Medicine, Medical University Vienna, Austria.
Müllner
Marcus
M
Sterz
Fritz
F
Robak
Oliver
O
Kliegel
Andreas
A
Losert
Heidrun
H
Sodeck
Gottfried
G
Uray
Thomas
T
Zeiner
Andrea
A
Laggner
Anton N
AN
D000368:Aged; D001317:Austria / Q000453:epidemiology; D001499:Bayes Theorem; D001831:Body Temperature; D001919:Bradycardia / Q000209:etiology; D001925:Brain Damage, Chronic / Q000209:etiology / Q000517:prevention & control; D015331:Cohort Studies; D005260:Female; D006323:Heart Arrest / Q000150:complications / Q000401:mortality / Q000628:therapy*; D017052:Hospital Mortality; D006801:Humans; D007036:Hypothermia, Induced / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D020925:Hypoxia-Ischemia, Brain / Q000209:etiology / Q000517:prevention & control; D007262:Infusions, Intravenous; D007552:Isotonic Solutions / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D000077325:Ringer's Lactate; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome; D014682:Vena Cava, Inferior
D007552:Isotonic Solutions; D000077325:Ringer's Lactate