A Comparison of Therapeutic Hypothermia and Strict Therapeutic Normothermia after Cardiac Arrest

• Published in: Resuscitation Vol. 106; pp. 83 - 88
• Main Authors: Casamento, Andrew, Minson, Adrian, Radford, Samuel, Mårtensson, Johan, Ridgeon, Elliott, Young, Paul, Bellomo, Rinaldo
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier Ireland Ltd 01-09-2016
• Subjects: Aged; Analgesics - therapeutic use; APACHE; Body Temperature; Cardiac arrest; Coma - therapy; Controlled Before-After Studies; Emergency; Female; Heart Arrest - complications; Heart Arrest - therapy; Humans; Hypnotics and Sedatives - therapeutic use; Hypothermia, Induced - adverse effects; Intensive Care Units; Length of Stay; Male; Medicin och hälsovetenskap; Middle Aged; Muscle Relaxants, Central - therapeutic use; Reproducibility of Results; Retrospective Studies; Strict therapeutic normothermia; Targeted temperature management; Therapeutic hypothermia; Therapeutic hypothermia; Strict therapeutic normothermia; Cardiac arrest; Targeted temperature management
• ISSN: 0300-9572; 1873-1570; 1873-1570
• DOI: 10.1016/j.resuscitation.2016.06.019

Abstract Background and Aims In a recent high-quality randomised controlled trial (RCT), strict therapeutic normothermia (STN) following cardiac arrest with coma resulted in similar outcomes to therapeutic hypothermia (TH). We aimed to test the feasibility, reproducibility, and safety of the STN protocol outside of its RCT context. Methods In two teaching hospital ICUs, we performed a before-and-after study comparing the previously International Liaison Committee on Resuscitation (ILCOR)-endorsed TH protocol to the recently studied STN protocol. The primary feasibility end point was the percentage of temperature recordings in the prescribed range in the first 24 hours of treatment. Secondary end points included pharmacological management and complications. Results We studied 69 similar patients in each group. We found no difference in feasibility as shown by the proportion of within range temperatures. However, the median doses of midazolam (37 mg vs. 9 mg, p = 0.02), fentanyl (883mcg vs. 310mcg, p = 0.01) and the use of muscle relaxants (84.1% vs. 59.4%, p = 0.001) was greater with the TH protocol. Furthermore, shivering (52.2% vs. 18.8%, p < 0.001), a composite of other pre-defined complications (66.7% vs. 47.8%, p < 0.03) and fever in the first 96 hours (55.1% vs. 33.3%, p = 0.01) were also more common with the TH protocol. Conclusions The STN protocol was successfully reproduced outside of an RCT and appeared associated with fewer complications than the TH protocol. Our findings imply that the STN protocol may offer clinical advantages over the TH protocol.