EBQ:HACA

incomplete Journal Club Article

Holzer M, et al. "Mild Therapeutic Hypothermia to Improve the Neurologic Outcome After Cardiac Arrest". The New England Journal of Medicine. 2002. 346(8):549-556.
PubMed Full text PDF

Clinical Question

Does mild hypothermia improve neurologic outcomes compared with standard care normothermia in patients surviving ventricular fibrillation or pulseless ventricular tachycardic arrest?

Conclusion

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

Major Points

Therapeutic Hypothermia, define as deliberate cooling of a patient to 32-33.9°C (90-93F) who has no return of spontaneous neurologic activity after cardiac arrest. The goal is to reduce the repercussion injury to the brain which may be related to free radical formation, micro and macro circulation disruption and protease activation. At therapeutic temperatures the disruption of inflammatory and damaging cascades within the brain are thought to be decreased. ^[1]

The HACA Trial (Hypothermia after Cardiac Arrest) randomized patients after witness Ventricular Fibrillation (VF) and pulseless Ventricular Tachycardia (VT) to 32-34°C Hypothermia. There was a significant patient centered outcome and 6 month mortality decrease in the hypothermia group. A later trial by Bernard et. al. demonstrated similar benefit and subsequent Cochrane reviews and the TTM Trial (33°C vs 33°C) found similar mortality and morbidity benefits.^[1]

Standard care established by the ACCF/AHA 2013 guidelines, recommend therapeutic hypothermia for any comatose patient with a STEMI and out of hospital cardiac arrest from VF or puleless VT^[2]

Study Design

Randomized, Multicenter, unblinded treatment with blinded final outcome assessment.
N=275
- Normothermia control group (n=138)
- Hypothermia treatment group (n=137)

Population

Emergency Department enrollment

Patient Demographics

Inclusion Criteria

Exclusion Criteria

Interventions

Outcomes

Primary Outcome

Secondary Outcomes

Subgroup analysis

Criticisms & Further Discussion

Funding

Sources

↑ ^1.0 ^1.1 Arrich J, Holzer M, Herkner H, Müllner M. Hypothermia for neuroprotection in adults after cardiopulmonary resuscitation. Cochrane Database of Systematic Reviews 2009. PMID
↑ http://www.ncbi.nlm.nih.gov/pubmed/23256913

Authors:

[Cochrane-1] 1.0 ^1.1 Arrich J, Holzer M, Herkner H, Müllner M. Hypothermia for neuroprotection in adults after cardiopulmonary resuscitation. Cochrane Database of Systematic Reviews 2009. PMID

[2] ttp://www.ncbi.nlm.nih.gov/pubmed/23256913

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