Temperature Control After In-Hospital Cardiac Arrest: A Randomized Clinical Trial

• DOI: 10.1161/circulationaha.122.060106
• Publication Date: 2022-10-19T14:43:58Z
• Authors: Sebastian Wolfrum; Kevin Roedl; Alexia Hanebutte; Rüdiger Pfeifer; Volkhard Kurowski; Reimer Riessen; Anne Daubmann; Stephan Braune; Gerold Söffker; Eric Bibiza-Freiwald; Karl Wegscheider; Heribert Schunkert; Holger Thiele; Stefan Kluge
• Keywords: Male; Aged, 80 and over; Temperature; Middle Aged; Hospitals; Cardiopulmonary Resuscitation; 03 medical and health sciences; 0302 clinical medicine; Treatment Outcome; Hypothermia, Induced; Humans; Female; Coma; Out-of-Hospital Cardiac Arrest; Aged

Background: This study was conducted to determine the effect of hypothermic temperature control after in-hospital cardiac arrest (IHCA) on mortality and functional outcome as compared with normothermia. Methods: An investigator initiated, open-label, blinded-outcome-assessor, multicenter, randomized controlled trial comparing (32-34°C) for 24 h normothermia IHCA in 11 hospitals Germany. The primary endpoint all-cause 180 days. Secondary end points included favorable using Cerebral Performance Category scale A score 1 or 2 defined a outcome. Results: total 1055 patients were screened eligibility 249 randomized: 126 assigned 123 mean age cohort 72.6±10.4 years, 64% (152 236) male, 73% (166 227) arrests witnessed, 25% (57 231) had an initial shockable rhythm, time return spontaneous circulation 16.4±10.5 minutes. Target reached within 4.2±2.8 hours randomization group 48 at 37.0°±0.9°C group. Mortality by day 72.5% (87 120) arm, 71.2% (84 118) (relative risk, 1.03 [95% CI, 0.79–1.40]; P =0.822). In-hospital 62.5% (75 57.6% (68 1.11 0.86–1.46, =0.443). Favorable (Cerebral 2) 22.5% (27 control, 23.7% (28 1.04 0.78–1.44]; prematurely terminated because futility. Conclusions: Hypothermic did not improve survival nor presenting coma IHCA. HACA (Hypothermia After Cardiac Arrest in-hospital) underpowered may have failed detect clinically important differences between Registration: URL: https://www.clinicaltrials.gov ; Unique Identifier: NCT00457431.