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Mild therapeutic hypothermia after cardiac arrest - effect on survival with good neurological outcome outside of randomised controlled trials: A registry-based analysis.
Knapp, Jürgen; Steffen, Richard; Huber, Markus; Heilman, Sandra; Rauch, Stefan; Bernhard, Michael; Fischer, Matthias.
Afiliación
  • Knapp J; From the Department of Anaesthesiology and Pain Medicine, Bern University Hospital, Inselspital, University of Bern, Bern (JK, RS, MH), Swiss Air-Rescue (Rega), Zurich, Switzerland (JK), the Department of Anaesthesiology, Intensive Care Medicine, Emergency Medicine, and Pain Therapy, Alb Fils Kliniken, Göppingen (SH, SR, MF), the Emergency Department, University Hospital, Heinrich-Heine University, Düsseldorf, Germany (MB).
Eur J Anaesthesiol ; 41(10): 779-786, 2024 Oct 01.
Article en En | MEDLINE | ID: mdl-39228239
ABSTRACT

BACKGROUND:

For nearly 20 years, in international guidelines, mild therapeutic hypothermia (MTH) was an important component of postresuscitation care. However, recent randomised controlled trials have questioned its benefits. At present, international guidelines only recommend actively preventing fever, but there are ongoing discussions about whether the majority of cardiac arrest patients could benefit from MTH treatment.

OBJECTIVE:

The aim of this study was to compare the outcome of adult patients treated with and without MTH after cardiac arrest.

DESIGN:

Observational cohort study.

SETTING:

German Resuscitation Registry covering more than 31 million inhabitants of Germany and Austria. PATIENTS All adult patients between 2006 and 2022 with out-of-hospital or in-hospital cardiac arrest and comatose on admission. MAIN OUTCOME

MEASURES:

Primary endpoint hospital discharge with good neurological outcome [cerebral performance categories (CPC) 1 or 2]. Secondary endpoint hospital discharge. We used a multivariate binary logistic regression analysis to identify the effects on outcome of all known influencing variables.

RESULTS:

We analysed 33 933 patients (10 034 treated with MTH, 23 899 without MTH). The multivariate regression model revealed that MTH was an independent predictor of CPC 1/2 survival and of hospital discharge with odds ratio (95% confidence intervals) of 1.60 (1.49 to 1.72), P < 0.001 and 1.89 (1.76 to 2.02), P < 0.001, respectively.

CONCLUSION:

Our data indicate the existence of a positive association between MTH and a favourable neurological outcome after cardiac arrest. It therefore seems premature to refrain from giving MTH treatment for the entire spectrum of patients after cardiac arrest. Further prospective studies are needed.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Sistema de Registros / Paro Cardíaco / Hipotermia Inducida Límite: Aged / Aged80 / Female / Humans / Male / Middle aged País/Región como asunto: Europa Idioma: En Revista: Eur J Anaesthesiol Asunto de la revista: ANESTESIOLOGIA Año: 2024 Tipo del documento: Article Pais de publicación: Reino Unido
Texto completo
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XML
PubMed Links
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Sistema de Registros / Paro Cardíaco / Hipotermia Inducida Límite: Aged / Aged80 / Female / Humans / Male / Middle aged País/Región como asunto: Europa Idioma: En Revista: Eur J Anaesthesiol Asunto de la revista: ANESTESIOLOGIA Año: 2024 Tipo del documento: Article Pais de publicación: Reino Unido