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Mild Therapeutic Hypothermia to Improve the Neurologic Outcome after Cardiac Arrest
The Hypothermia after Cardiac Arrest Study Group
New England Journal of Medicine:   Vol. 346:549-556  February 21, 2002  Number 8

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@akh-wien.ac.at.

Editorial in same issue

   (Just small image) 
Cerebral injury and associated cognitive dysfunction are common after sustained cardiac arrest. In this study, mild therapeutic hypothermia was compared with normothermia in patients who had been resuscitated after cardiac arrest due to ventricular fibrillation. A favorable neurologic outcome was significantly more frequent in the group treated with hypothermia.

These results, in conjunction with those of another study in this issue, suggest that mild therapeutic hypothermia may have a substantial benefit in patients who have been resuscitated after cardiac arrest and that this approach should now be considered in the care of such patients.

Wall Street Journal excerpts from issue of Feb 21, 2002
"..recommends that cooling of comatose cardiac-arrest victims should begin immediately "as part of a standard cardiopulmonary resuscitation." 

"The modern methods involve a much milder cooling, to about 92 degrees Fahrenheit."

"The European researchers used a blower to bathe cardiac arrest patients in cold air for 24 hours."

"In their study, 55% of the 136 patients treated with mild hypothermia recovered all or most of their mental function compared to 39% of patients kept at normal temperature."

See also: Cool the brain AND supply oxygen before arriving at the hospital   
Might increase survival of sudden cardiac arrest from 5% to 30%  added 11/21/01