15 Sep Hypothermia for 48 or 24 Hours After Out-of-Hospital Cardiac Arrest?
MedicalResearch.com Interview with:
Hans Kirkegaard, MD, PhD, DMSci, DEAA, DLS
Research Center for Emergency Medicine and
Department of Anesthesiology and Intensive Care Medicine
Aarhus University Hospital and Aarhus University
MedicalResearch.com: What is the background for this study?
Response: In 2002, two landmark studies demonstrated that mild therapeutic hypothermia (now known as targeted temperature management, TTM) for 12 or 24 hours improves neurological outcome in adult comatose patients suffering from out of hospital cardiac arrest. Accordingly, international guidelines now recommend TTM for at least 24 hours in this patient group.
However, there are no studies, only case reports that explore the effect of prolonged cooling. We therefore wanted to set up a trial that could fill out this knowledge gap, we hypothesized that doubling the hypothermia dose to 48 hour would improve neurological outcome without increasing the risk of adverse events considerably.
MedicalResearch.com: What are the main findings?
Response: The primary finding in our study was that we did not detect a statistically significant difference in good neurological outcome between the 48 and 24-hour group. Good neurological outcome was defined as Cerebral Performance Category score of 1 or 2 at 6 month. However, it is important to remember that our study was powered to detect a 15% absolute difference. We found a smaller difference of 5%, that still may be clinical relevant. It is also noteworthy that both arms had a low mortality rate, 27% in the 48-hour group and 34% in the 24-hour group. It is also notable that 84 and 82 % of patients in the two groups had bystander-initiated CPR and 83 and 82 % of patients % had immediately coronary angiography and PCI if needed. We believe that these high rates contributes to the low mortality.
MedicalResearch.com: What should readers take away from your report?
Response: The results of the study will not change current international guidelines, but it demonstrates that prolonged cooling is safe and may even have a beneficial effect, especially in younger patients. Subgroup analyses in patients under the age of 60 demonstrated an absolute difference of 10 % in good neurological outcome in favor of the 48-hour group.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: A larger study may be warranted to check out if the 5% difference between the groups is indeed real. However, this will require approximately 3000 patient. However, it may be more interesting and relevant to repeat the study in a younger patient group. The difference between the groups in the under 60 years of age population were bigger and in favor of the 48-hour group. A study in this group would therefore require much less patients.
Disclosures: No conflicts
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Kirkegaard H, Søreide E, de Haas I, Pettilä V, Taccone FS, Arus U, Storm C, Hassager C, Nielsen JF, Sørensen CA, Ilkjær S, Jeppesen AN, Grejs AM, Duez CHV, Hjort J, Larsen AI, Toome V, Tiainen M, Hästbacka J, Laitio T, Skrifvars MB. Targeted Temperature Management for 48 vs 24 Hours and Neurologic Outcome After Out-of-Hospital Cardiac ArrestA Randomized Clinical Trial. JAMA. 2017;318(4):341–350. doi:10.1001/jama.2017.8978
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Last Updated on September 15, 2017 by Marie Benz MD FAAD