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Previous Volume 346:549-556 February 21, 2002 Number 8 Next

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ABSTRACT

Background Cardiac arrest with widespread cerebral ischemia frequently leads to severe neurologic impairment. We studied whether mild systemic hypothermia increases the rate of neurologic recovery after resuscitation from cardiac arrest due to ventricular fibrillation.

Methods In this multicenter trial with blinded assessment of the outcome, patients who had been resuscitated after cardiac arrest due to ventricular fibrillation were randomly assigned to undergo therapeutic hypothermia (target temperature, 32°C to 34°C, measured in the bladder) over a period of 24 hours or to receive standard treatment with normothermia. The primary end point was a favorable neurologic outcome within six months after cardiac arrest; secondary end points were mortality within six months and the rate of complications within seven days.

Results Seventy-five of the 136 patients in the hypothermia group for whom data were available (55 percent) had a favorable neurologic outcome (cerebral-performance category, 1 [good recovery] or 2 [moderate disability]), as compared with 54 of 137 (39 percent) in the normothermia group (risk ratio, 1.40; 95 percent confidence interval, 1.08 to 1.81). Mortality at six months was 41 percent in the hypothermia group (56 of 137 patients died), as compared with 55 percent in the normothermia group (76 of 138 patients; risk ratio, 0.74; 95 percent confidence interval, 0.58 to 0.95). The complication rate did not differ significantly between the two groups.

Conclusions In patients who have been successfully resuscitated after cardiac arrest due to ventricular fibrillation, therapeutic mild hypothermia increased the rate of a favorable neurologic outcome and reduced mortality.

Source Information

Michael Holzer, M.D., Universitätsklinik für Notfallmedizin, Vienna, Austria, assumes overall responsibility for the integrity of the report.

Address reprint requests to Dr. Fritz Sterz, Universitätsklinik für Notfallmedizin, Allgemeines Krankenhaus der Stadt Wien, Währinger Gürtel 18–20/6D, 1090 Vienna, Austria or at fritz.sterz{at}akh-wien.ac.at.

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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