02 Oct Cardiac Arrest with Nonshockable Rhythm: Targeted Temperature Management
MedicalResearch.com Interview with:
Dr. Baptiste Lascarrou
Dr Jean-Baptiste Lascarrou
Médecine Intensive Réanimation
CHU de Nantes
Nantes
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Ancillary study of TTM1 trial & meta-analyses of nonrandomized studies have provided conflicting data on moderate therapeutic hypothermia, or targeted temperature management, at 33°C in patients successfully resuscitated after nonshockable cardiac arrest.
Nevertheless, the latest recommendations issued by the International Liaison Committee on Resuscitation and by the European Resuscitation Council recommend moderate therapeutic hypothermia.
MedicalResearch.com: What are the main findings?
Response: HYPERION demonstrates than moderate therapeutic hypothermia at 33°C (MTH) improved survival with a favorable day-90 neurological outcome compared to targeted normothermia in comatose survivors of in- or out-of-hospital cardiac arrest with nonshockable rhythm due to cardiac or noncardiac causes.
MedicalResearch.com: What should readers take away from your report?
Response: Moderate therapeutic hypothermia at 33° must be perform in accordance to non-inclusion criteria of the HYPERION trial (briefly no-flow>10min & low-flow>60min, norepinephrine infusion >1µg/kg/min). MTH must be perform for out-of-hospital AND in-hospital cardiac arrest. MTH must be perform during 24hrs with slow rewarming and targeted normothermia after during additional 24hrs.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: HYPERION supports MTH 33° use after cardiac arrest especially for patients in non-shockable rhythm and poor prognosis. Furthers studies must determine how to best perform MTH (patient’s selection for temperature target with early neurological prognosis score such as CAHP score) and associate treatments (speed of rewarming (NCT02555254) sedation, neuromuscular blockade, nutrition…).
MedicalResearch.com: Is there anything else you would like to add?
Response: The trial was supported by independent research grants from the French Ministry of Health, the nonprofit healthcare institution Centre Hospitalier Departement de la Vendee, and the Laerdal Foundation. None of the study funders had any role in trial design, in data collection or analysis, or in the writing of the manuscript.
Citations:
Targeted Temperature Management for Cardiac Arrest with Nonshockable Rhythm
Jean-Baptiste Lascarrou, M.D., Hamid Merdji, M.D., Ph.D., Amélie Le Gouge, M.Sc., Gwenhael Colin, M.D., Guillaume Grillet, M.D., Patrick Girardie, M.D., Elisabeth Coupez, M.D., Pierre-François Dequin, M.D., Ph.D., Alain Cariou, M.D., Ph.D., Thierry Boulain, M.D., Noelle Brule, M.D., Jean-Pierre Frat, M.D., Ph.D., et al., for the CRICS-TRIGGERSEP Group*
October 2, 2019
DOI: 10.1056/NEJMoa1906661
https://www.nejm.org/doi/full/10.1056/NEJMoa1906661?query=featured_home
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Last Updated on October 2, 2019 by Marie Benz MD FAAD