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Previous Volume 346:557-563 February 21, 2002 Number 8 Next

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ABSTRACT

Background Cardiac arrest outside the hospital is common and has a poor outcome. Studies in laboratory animals suggest that hypothermia induced shortly after the restoration of spontaneous circulation may improve neurologic outcome, but there have been no conclusive studies in humans. In a randomized, controlled trial, we compared the effects of moderate hypothermia and normothermia in patients who remained unconscious after resuscitation from out-of-hospital cardiac arrest.

Methods The study subjects were 77 patients who were randomly assigned to treatment with hypothermia (with the core body temperature reduced to 33°C within 2 hours after the return of spontaneous circulation and maintained at that temperature for 12 hours) or normothermia. The primary outcome measure was survival to hospital discharge with sufficiently good neurologic function to be discharged to home or to a rehabilitation facility.

Results The demographic characteristics of the patients were similar in the hypothermia and normothermia groups. Twenty-one of the 43 patients treated with hypothermia (49 percent) survived and had a good outcome — that is, they were discharged home or to a rehabilitation facility — as compared with 9 of the 34 treated with normothermia (26 percent, P=0.046). After adjustment for base-line differences in age and time from collapse to the return of spontaneous circulation, the odds ratio for a good outcome with hypothermia as compared with normothermia was 5.25 (95 percent confidence interval, 1.47 to 18.76; P=0.011). Hypothermia was associated with a lower cardiac index, higher systemic vascular resistance, and hyperglycemia. There was no difference in the frequency of adverse events.

Conclusions Our preliminary observations suggest that treatment with moderate hypothermia appears to improve outcomes in patients with coma after resuscitation from out-of-hospital cardiac arrest.

Source Information

From the Intensive Care Unit, Dandenong Hospital, Dandenong (S.A.B., M.D.B.); the Intensive Care Unit, Knox Hospital, Wantirna South, Melbourne (S.A.B., M.D.B., B.M.J.); the Metropolitan Ambulance Service, Victoria (S.A.B.); the Department of Emergency Medicine, Monash Medical Centre, Clayton (T.W.G.); the Department of Intensive Care, Austin and Repatriation Medical Centre, Heidelberg (W.S., G.G.); and the Monash University Department of Epidemiology and Preventive Medicine, St. Kilda (K.S.) — all in Australia.

Address reprint requests to Dr. Bernard at Dandenong Hospital, David St., Dandenong, VIC 3175, Australia, or at s.bernard{at}southernhealth.org.au.

Full Text of this Article

Related Letters:

Therapeutic Hypothermia after Cardiac Arrest
Darby J. M., Padosch S. A., Kern K. B., Böttiger B. W., Polderman K. H., Girbes A. R.J., Holzer M., the Hypothermia after Cardiac Arrest Study Group , Bernard S. A., Buist M. D., Safar P., Kochanek P. M.
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N Engl J Med 2002; 347:63-65, Jul 4, 2002. Correspondence

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