Effect of prehospital induction of mild hypothermia on survival and neurologic status among adults with cardiac arrest: a randomized clinical trial
By Francis Kim, G. Nichol, C. Maynard, A. Hallstrom, P. Kudenchuk, T. Rea, M. Copass, D. Carlbom, S. Deem, W. Longstreth and 2 more. Journal of the American Medical Association (JAMA), 2014
597 citations recorded by the source corpus.
Importance: Delayed hospital cooling improves outcome after cardiac arrest, but pre-hospital cooling immediately after return of spontaneous circulation (RoSC) may be better. Objective: To determine whether in-field cooling improves outcomes after resuscitation from cardiac arrest with ventricular fibrillation (VF) and without (non-VF). Design, Setting, Participants: This randomized trial assigned adults with out-of-hospital cardiac arrest to standard care with or without pre-hospital cooling, accomplished by infusing up to 2 liters of 4°C normal saline as soon as possible following RoSC. All adults in King County, Washington, with out-of-hospital cardiac arrest and resuscitated by paramedics, were eligible, and 1359 patients (583 VF and 776 non-VF) were randomized. Nearly all of the resuscitated VF patients admitted to the hospital received hospital cooling regardless of their randomization. Main outcome measures: The primary outcomes were survival to hospital discharge and neurological status at discharge. Results: Although the intervention dropped mean core temperature by more than 1°C by hospital arrival and reduced by about one hour the time to achieve a temperature of less then 34°C compared to the control group, primary outcomes did not differ by treatment status. Among patients with VF, survival to hospital discharge was 62.5% in the intervention group vs. 64.3% in the control group, p=0.69. Among patients with non-VF, survival to discharge was 19.2% in the intervention group vs. 16.3% in the control group, p=0.3. Overall, the intervention group experienced re-arrest in the field more than the control group (26% vs. 21%, p=0.007), as well as increased diuretic use and pulmonary edema on first chest x-ray, which resolved within 12 hours after admission. Conclusions: Although use of early, pre-hospital cooling reduced core temperature by hospital arrival and reduced the time to reach 34°C, it did not improve survival or neurological status among patients resuscitated from out-of-hospital VF or non-VF.
Subfields: Critical Care and Intensive Care Medicine, Emergency Medicine, Health, Toxicology and Mutagenesis
View Paper: https://www.semanticscholar.org/paper/5596e75c398b111d08b5973c0a3fa77984fdada7
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In Emergency Medicine
Citations in the corpus
- Part 8: Post–Cardiac Arrest Care (2015, unknown): “patients treated with a goal of prehospital infusion of 2 L of cold fluids.(57)”
- 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. (2017, background): “after return of spontaneous circulation is not recommended.(86) III B”
- European Resuscitation Council and European Society of Intensive Care Medicine Guidelines 2021: Post-resuscitation care. (2021, background): “Three small RCTs and a large observational study have addressed the use of steroids in post-cardiac arrest patients [163–166].”