title: Mild therapeutic hypothermia improves outcomes compared with normothermia in cardiac-arrest patients--a retrospective chart review.
abstract: OBJECTIVE
  Studies showing the effectiveness of therapeutic hypothermia (32-34°C) in postcardiac arrest patients have been criticized because of patients with elevated body temperature (>37.5°C) in the noncooled control group. Thus, the effects of spontaneous normothermia (<37.5°C) compared with mild therapeutic hypothermia were studied.
  
  
  METHODS
  Retrospective chart review from 1991 to 2010.
  
  
  METHODS
  Witnessed out-of-hospital arrest, presumed to be of cardiac origin, aged 18 to 80 yrs and with a Glassgow Coma Scale score of <8 at admission.
  
  
  METHODS
  Patients with sustained restoration of spontaneous circulation who did not receive therapeutic hypothermia and never exceeded 37.5°C during the 36 hrs postcardiac arrest were compared with patients who received mild therapeutic hypothermia.
  
  
  RESULTS
  The primary end point was a favorable neurological outcome, defined as Cerebral Performance Categories 1 or 2; the secondary end point was overall survival to 180 days. Significantly more patients in the hypothermia group had Cerebral Performance Categories 1 or 2 (hypothermia: 256 of 467 [55%] vs. normothermia: 69 of 165 [42%]) and survived for >180 days (hypothermia: 315 of 467 [67%] vs. normothermia: 79 of 165 [48%]). The propensity score adjusted risk ratio for good neurological outcome of patients undergoing hypothermia treatment was 1.37 (confidence interval 1.09-1.72, p≤.01) and for dying within 180 days was 0.57 (confidence interval 0.44-0.73, p≤.01) compared to normothermia.
  
  
  CONCLUSIONS
  Therapeutic hypothermia is associated with significantly improved neurological outcome and 180-day survival compared to spontaneous normothermia in cardiac-arrest patients.
authors.affiliation: Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria.
authors.forename: David
authors.initials: D
authors.lastname: Hörburger
authors.forename: Christoph
authors.initials: C
authors.lastname: Testori
authors.forename: Fritz
authors.initials: F
authors.lastname: Sterz
authors.forename: Harald
authors.initials: H
authors.lastname: Herkner
authors.forename: Danica
authors.initials: D
authors.lastname: Krizanac
authors.forename: Thomas
authors.initials: T
authors.lastname: Uray
authors.forename: Andreas
authors.initials: A
authors.lastname: Schober
authors.forename: Mathias
authors.initials: M
authors.lastname: Stöckl
authors.forename: Peter
authors.initials: P
authors.lastname: Stratil
authors.forename: Christoph
authors.initials: C
authors.lastname: Weiser
authors.forename: Christian
authors.initials: C
authors.lastname: Wallmüller
authors.forename: Michael
authors.initials: M
authors.lastname: Holzer
mesh_terms: D000368:Aged; D001831:Body Temperature / Q000502:physiology; D016887:Cardiopulmonary Resuscitation; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007036:Hypothermia, Induced; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D057216:Propensity Score; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome