title: Impact of intra-arrest therapeutic hypothermia in outcomes of prehospital cardiac arrest: a randomized controlled trial.
abstract: OBJECTIVE
  Mild therapeutic hypothermia (TH) is recommended as soon as possible after the return of spontaneous circulation to improve outcomes after out-of-hospital cardiac arrest (OHCA). Preclinical data suggest that the benefit of TH could be increased if treatment is started during cardiac arrest. We aimed to study the impact of intra-arrest therapeutic hypothermia (IATH) on neurological injury and inflammation following OHCA.
  
  
  METHODS
  We conducted a 1:1 randomized, multicenter study in three prehospital emergency medical services and four critical care units in France. OHCA patients, irrespective of the initial rhythm, received either an infusion of cold saline and external cooling during cardiac arrest (IATH group) or TH started after hospital admission (hospital-cooling group). The primary endpoint was neuron-specific enolase (NSE) serum concentrations at 24 h. Secondary endpoints included IL-6, IL-8, and IL-10 concentrations, and clinical outcome.
  
  
  RESULTS
  Of the 245 patients included, 123 were analyzed in the IATH group and 122 in the hospital-cooling group. IATH decreased time to reach temperature ≤ 34 °C by 75 min (95% CI: 4; 269). The rate of patients admitted alive to hospital was not different between groups [IATH n = 41 (33%) vs. hospital cooling n = 36 (30%); p = 0.51]. Levels of NSE and inflammatory biomarkers were not different between groups [median NSE at 24 h: IATH 96.7 μg/l (IQR: 49.9-142.8) vs. hospital cooling 97.6 μg/l (IQR: 74.3-142.4), p = 0.64]. No difference in survival and cerebral performance were found at 1 month.
  
  
  CONCLUSIONS
  IATH did not affect biological markers of inflammation or brain damage or clinical outcome.
authors.affiliation: UJF-Grenoble 1/CNRS/TIMC-IMAG UMR 5525/Team PRETA, 38041, Grenoble, France, gdebaty@chu-grenoble.fr.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Debaty
authors.forename: Maxime
authors.initials: M
authors.lastname: Maignan
authors.forename: Dominique
authors.initials: D
authors.lastname: Savary
authors.forename: François-Xavier
authors.initials: FX
authors.lastname: Koch
authors.forename: Stéphane
authors.initials: S
authors.lastname: Ruckly
authors.forename: Michel
authors.initials: M
authors.lastname: Durand
authors.forename: Julien
authors.initials: J
authors.lastname: Picard
authors.forename: Christophe
authors.initials: C
authors.lastname: Escallier
authors.forename: Renaud
authors.initials: R
authors.lastname: Chouquer
authors.forename: Charles
authors.initials: C
authors.lastname: Santre
authors.forename: Clemence
authors.initials: C
authors.lastname: Minet
authors.forename: Dorra
authors.initials: D
authors.lastname: Guergour
authors.forename: Laure
authors.initials: L
authors.lastname: Hammer
authors.forename: Hélène
authors.initials: H
authors.lastname: Bouvaist
authors.forename: Loic
authors.initials: L
authors.lastname: Belle
authors.forename: Christophe
authors.initials: C
authors.lastname: Adrie
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Payen
authors.forename: Françoise
authors.initials: F
authors.lastname: Carpentier
authors.forename: Pierre-Yves
authors.initials: PY
authors.lastname: Gueugniaud
authors.forename: Vincent
authors.initials: V
authors.lastname: Danel
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Timsit
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000209:etiology* / Q000517:prevention & control*; D003080:Cold Temperature; D005260:Female; D005602:France; D006801:Humans; D007036:Hypothermia, Induced; D007249:Inflammation / Q000209:etiology* / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000150:complications* / Q000628:therapy*; D012965:Sodium Chloride / Q000008:administration & dosage; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D012965:Sodium Chloride