Therapeutic Hypothermia post cardiac arrest

This is a bit off-topic for this blog, but many of you will know that cooling is now used for many other patients than just our full-term asphyxias. Adults who remain with depressed levels of consciousness after resuscitation from a cardiac arrest are cooled for 24 hours, data showing better survival are relatively convincing especially after ventricular fibrillation and other shockable rhythms. The effects on adults with asystole or pulseless electrical activity have been less convincing, hence a nice multicenter trial from France in exactly such patients.

Lascarrou JB, et al. Targeted Temperature Management for Cardiac Arrest with Nonshockable Rhythm. N Engl J Med. 2019.

Basically, it worked! The figure below shows the benefit, with the 5 outcomes being death in grey, persistent vegetative state is outcome cerebral performance category 4; 3 is severe disability, meaning conscious but dependent on others for activities of daily life (dark blue); 2 is moderate disability meaning relative independence but includes dysphasia, hemiparesis, ataxia, personality and intellectual changes; 1 is a good recovery with only minor impacts on functtion.

Being alive with a grade 1 or 2 outcome at 90 days was the primary outcome variable which improved from 5.7% to 10.2%, normothermia compared to cooling. There being no difference in mortality, 90 day outcomes were the difference.

What I find striking is the contrast in the interpretation of these outcomes to the outcomes of extremely preterm infants. In preterm infants this would, in many places, be considered going from profoundly bad, and not worthy of intensive care, to a little less profoundly bad and still not worthy of intensive care!

It is interesting that this study was done in France, where, in the same academic centers where these adult patients are being treated, intervention for infants born at 23 weeks is rare. Infants born at 23 weeks who receive intensive care have much better outcomes than these adults.

Makes you think…. I hope.

 

About keithbarrington

I am a neonatologist and clinical researcher at Sainte Justine University Health Center in Montréal
This entry was posted in Neonatal Research and tagged . Bookmark the permalink.

1 Response to Therapeutic Hypothermia post cardiac arrest

  1. PH says:

    Looking at it through the eyes of a neo, one can project that it adds to our already known data that each day an ELBW survives and remains in the NICU, it increases chances towards survival. Unfortunately, for adults, the data are opposite….the downward spiral has already begun. The 2 or 5 year outcome data would be interesting to compare.

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