This article is more than 5 years old. Information may no longer be current.
Therapeutic hypothermia fails to benefit patients with in-hospital cardiac arrest
Click Here to Manage Email Alerts
Compared with the usual care, therapeutic hypothermia was associated with lower overall survival and favorable neurological survival in patients with in-hospital cardiac arrest, according to an observational study published in JAMA.
The researchers analyzed 26,183 patients with in-hospital cardiac arrest from the Get With the Guidelines–Resuscitation registry, 6% of whom were treated with therapeutic hypothermia and all of whom were successfully resuscitated. The events occurred between March 2002 and December 2014 and patients were followed until Feb. 4, 2015.
Paul S. Chan, MD, and colleagues performed propensity-score matching to compare 1,524 patients treated with hypothermia (mean age, 62 years; 59% men) with 3,714 patients treated with the usual care (mean age, 62 years; 57% men).
The primary outcome was survival to hospital discharge. The secondary outcome was favorable neurological survival, defined as a cerebral performance category score of 1 or 2.
Chan, from Saint Luke’s Mid-America Heart Institute, Kansas City, Missouri, and colleagues found that those treated with therapeutic hypothermia had a lower rate of in-hospital survival (27.4% vs. 29.2%; adjusted RR = 0.88; 95% CI, 0.8-0.97; risk difference, –3.6%; 95% CI, –6.3 to –0.9).
The lower survival rate for the hypothermia group occurred regardless of whether patients had nonshockable (22.2% vs. 24.5%; adjusted RR = 0.87; 95% CI, 0.76-0.99; risk difference, –3.2%; 95% CI, –6.2 to –0.3) or shockable cardiac arrest rhythms (41.3% vs. 44.1%; adjusted RR = 0.9; 95% CI, 0.77-1.05; risk difference, –4.6%; 95% CI, –10.9 to 1.7; P for interaction = .74), according to the researchers.
Favorable neurological survival was also lower in the hypothermia group (17% vs. 20.5%; adjusted RR = 0.79; 95% CI, 0.69-0.9; risk difference, –4.4; 95% CI, –6.8 to –2) regardless of rhythm type (P for interaction = .88), they wrote.
“When follow-up was extended to 1 year, there remained no survival advantage with the therapeutic hypothermia treatment,” Chan and colleagues wrote. “Collectively, these findings do not support current use of therapeutic hypothermia for patients with in-hospital cardiac arrest.” – by Erik Swain
Disclosure: Chan reports consulting for the American Heart Association, Johnson & Johnson and Optum Rx. Another researcher reports receiving personal fees from Amgen and grants from Boston Scientific, Gilead, GlaxoSmithKline and Novartis.
Click Here to Manage Email Alerts