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HYPERION: Moderate hypothermia beneficial for patients in coma after cardiac arrest

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Achieving moderate therapeutic hypothermia at 33°C improved survival with favorable neurologic outcome compared with normothermia in patients with coma who were resuscitated from cardiac arrest with nonshockable rhythm, according to results from the HYPERION trial.

The researchers randomly assigned 584 patients with coma (mean age, 67 years; 64% men) who had been admitted to the ICU after resuscitation from cardiac arrest with nonshockable rhythm. The results were presented at LIVES 2019, the meeting of the European Society of Intensive Care Medicine, and published in The New England Journal of Medicine.

The moderate therapeutic hypothermia group had a targeted temperature of 33°C for 24 hours, whereas the normothermia group had a targeted temperature of 37°C.

The primary endpoint of 90-day survival with favorable neurologic outcome, defined as Cerebral Performance Category scale score of 1 or 2, was achieved in 10.2% of the hypothermia group and 5.7% of the normothermia group (difference, 4.5 percentage points; 95% CI, 0.1-8.9), according to Jean-Baptiste Lascarrou, MD, from the Paris Cardiovascular Research Center, INSERM Unité 970, and colleagues.

All-cause mortality at 90 days did not differ between the groups (hypothermia, 81.3%; normothermia, 83.2%; difference, –1.9 percentage points, 95% CI, –8 to 4.3).

Adverse events were similar between the groups, and there were “no significant harmful effects” of hypothermia, the researchers wrote.

“Moderate therapeutic hypothermia improved the neurologic prognosis but not survival at 90 days, whereas the opposite has been reported for epinephrine,” the researchers wrote in NEJM. “The number needed to treat for one additional patient to survive with a Cerebral Performance Category score of 1 or 2 is 22 with hypothermia, as compared with a number needed to treat to prevent one death of 15 with bystander CPR and 112 with epinephrine.” – by Erik Swain

References:

Lascarrou JB, et al. Hot Topics Session. Presented at: LIVES 2019; Sept. 28-Oct. 2, 2019; Berlin.

Lascarrou JB, et al. N Engl J Med. 2019;doi:10.1056/NEJMoa1906661.

Disclosures: Lascarrou reports no relevant financial disclosures. Please see the study for the other authors’ relevant financial disclosures.