title: A comparison of therapeutic hypothermia and strict therapeutic normothermia after cardiac arrest.
abstract: In a recent high-quality randomised controlled trial (RCT), strict therapeutic normothermia (STN) following cardiac arrest with coma resulted in similar outcomes to therapeutic hypothermia (TH). We aimed to test the feasibility, reproducibility, and safety of the STN protocol outside of its RCT context.
  
  
  
  In two teaching hospital ICUs, we performed a before-and-after study comparing the previously International Liaison Committee on Resuscitation (ILCOR)-endorsed TH protocol to the recently studied STN protocol. The primary feasibility end point was the percentage of temperature recordings in the prescribed range in the first 24h of treatment. Secondary end points included pharmacological management and complications.
  
  
  
  We studied 69 similar patients in each group. We found no difference in feasibility as shown by the proportion of within range temperatures. However, the median doses of midazolam (37mg vs. 9mg, p=0.02), fentanyl (883μg vs. 310μg, p=0.01) and the use of muscle relaxants (84.1% vs. 59.4%, p=0.001) was greater with the TH protocol. Furthermore, shivering (52.2% vs. 18.8%, p<0.001), a composite of other pre-defined complications (66.7% vs. 47.8%, p<0.03) and fever in the first 96h (55.1% vs. 33.3%, p=0.01) were also more common with the TH protocol.
  
  
  
  The STN protocol was successfully reproduced outside of an RCT and appeared associated with fewer complications than the TH protocol. Our findings imply that the STN protocol may offer clinical advantages over the TH protocol.
authors.affiliation: Intensive Care Unit, Austin Hospital, Melbourne, Victoria, Australia; Intensive Care Unit, The Northern Hospital, Melbourne, Victoria, Australia. Electronic address: andrew.casamento@austin.org.au.
authors.forename: Andrew
authors.initials: A
authors.lastname: Casamento
authors.affiliation: Intensive Care Unit, Austin Hospital, Melbourne, Victoria, Australia.
authors.forename: Adrian
authors.initials: A
authors.lastname: Minson
authors.affiliation: Intensive Care Unit, Austin Hospital, Melbourne, Victoria, Australia; School of Medicine, The University of Melbourne, Victoria, Australia.
authors.forename: Samuel
authors.initials: S
authors.lastname: Radford
authors.affiliation: Intensive Care Unit, Austin Hospital, Melbourne, Victoria, Australia; Section of Anaesthesia and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Johan
authors.initials: J
authors.lastname: Mårtensson
authors.affiliation: Medical Research Institute of New Zealand, Wellington, New Zealand.
authors.forename: Elliott
authors.initials: E
authors.lastname: Ridgeon
authors.affiliation: Medical Research Institute of New Zealand, Wellington, New Zealand; Intensive Care Unit, Wellington Hospital, Wellington, New Zealand.
authors.forename: Paul
authors.initials: P
authors.lastname: Young
authors.affiliation: Intensive Care Unit, Austin Hospital, Melbourne, Victoria, Australia; School of Medicine, The University of Melbourne, Victoria, Australia.
authors.forename: Rinaldo
authors.initials: R
authors.lastname: Bellomo
mesh_terms: D018806:APACHE; D000368:Aged; D000700:Analgesics / Q000627:therapeutic use; D001831:Body Temperature; D003128:Coma / Q000628:therapy*; D065187:Controlled Before-After Studies; D005260:Female; D006323:Heart Arrest / Q000150:complications / Q000628:therapy*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D007036:Hypothermia, Induced / Q000009:adverse effects*; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009125:Muscle Relaxants, Central / Q000627:therapeutic use; D015203:Reproducibility of Results; D012189:Retrospective Studies
chemical_list: D000700:Analgesics; D006993:Hypnotics and Sedatives; D009125:Muscle Relaxants, Central
keywords: Cardiac arrest; Strict therapeutic normothermia; Targeted temperature management; Therapeutic hypothermia