Treatment of Comatose Survivors of Out-of-Hospital Cardiac Arrest with Induced Hypothermia
Stephen A. Bernard, M.B., B.S., Timothy W. Gray, M.B., B.S., Michael D. Buist, M.B., B.S., Bruce M. Jones, M.B., B.S., William Silvester, M.B., B.S., Geoff Gutteridge, M.B., B.S., and Karen Smith, B.Sc.
Background Cardiac arrest outside the hospital is common andhas a poor outcome. Studies in laboratory animals suggest thathypothermia induced shortly after the restoration of spontaneouscirculation may improve neurologic outcome, but there have beenno conclusive studies in humans. In a randomized, controlledtrial, we compared the effects of moderate hypothermia and normothermiain patients who remained unconscious after resuscitation fromout-of-hospital cardiac arrest.
Methods The study subjects were 77 patients who were randomlyassigned to treatment with hypothermia (with the core body temperaturereduced to 33°C within 2 hours after the return of spontaneouscirculation and maintained at that temperature for 12 hours)or normothermia. The primary outcome measure was survival tohospital discharge with sufficiently good neurologic functionto be discharged to home or to a rehabilitation facility.
Results The demographic characteristics of the patients weresimilar in the hypothermia and normothermia groups. Twenty-oneof the 43 patients treated with hypothermia (49 percent) survivedand had a good outcome — that is, they were dischargedhome or to a rehabilitation facility — as compared with9 of the 34 treated with normothermia (26 percent, P=0.046).After adjustment for base-line differences in age and time fromcollapse to the return of spontaneous circulation, the oddsratio for a good outcome with hypothermia as compared with normothermiawas 5.25 (95 percent confidence interval, 1.47 to 18.76; P=0.011).Hypothermia was associated with a lower cardiac index, highersystemic vascular resistance, and hyperglycemia. There was nodifference in the frequency of adverse events.
Conclusions Our preliminary observations suggest that treatmentwith moderate hypothermia appears to improve outcomes in patientswith 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.
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.
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