A multicentre randomized pilot trial on the effectiveness of different levels of cooling in comatose survivors of out-of-hospital cardiac arrest: the FROST-I trial

• Published in: Intensive care medicine Vol. 44; no. 11; pp. 1807 - 1815
• Main Authors: Lopez-de-Sa, Esteban, Juarez, Miriam, Armada, Eduardo, Sanchez-Salado, José C., Sanchez, Pedro L., Loma-Osorio, Pablo, Sionis, Alessandro, Monedero, Maria C., Martinez-Sellés, Manuel, Martín-Benitez, Juán C., Ariza, Albert, Uribarri, Aitor, Garcia-Acuña, José M., Villa, Patricia, Perez, Pablo J., Storm, Christian, Dee, Anne, Lopez-Sendon, Jose L.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-11-2018; Springer; Springer Nature B.V
• Subjects: Ambulance services; Analysis; Anesthesiology; Cardiac arrest; Cardiopulmonary resuscitation; Cardiovascular system; Coma; Cooling; Cooling effects; CPR; Critical Care Medicine; Defibrillators; Emergency Medicine; Evidence-based medicine; Hazard identification; Heart; Heart attacks; Intensive; Intensive care; Medicine; Medicine & Public Health; NCT; NCT02035839; Original; Pain Medicine; Patients; Pediatrics; Pneumology/Respiratory System; Randomization; Statistical analysis; Statistical models; Spain; Post-cardiac arrest syndrome; Sudden death; Brain injury; Resuscitation; Cardiac arrest; Targeted temperature management
• ISSN: 0342-4642; 1432-1238
• DOI: 10.1007/s00134-018-5256-z

Purpose
To obtain initial data on the effect of different levels of targeted temperature management (TTM) in out-of-hospital cardiac arrest (OHCA).
Methods
We designed a multicentre pilot trial with 1:1:1 randomization to either 32 °C (
n
 = 52), 33 °C (
n
 = 49) or 34 °C (
n
 = 49), via endovascular cooling devices during a 24-h period in comatose survivors of witnessed OHCA and initial shockable rhythm. The primary endpoint was the percentage of subjects surviving with good neurologic outcome defined by a modified Rankin Scale (mRS) score of ≤ 3, blindly assessed at 90 days.
Results
At baseline, different proportions of patients who had received defibrillation administered by a bystander were assigned to groups of 32 °C (13.5%), 33 °C (34.7%) and 34 °C (28.6%;
p
 = 0.03). The percentage of patients with an mRS ≤ 3 at 90 days (primary endpoint) was 65.3, 65.9 and 65.9% in patients assigned to 32, 33 and 34 °C, respectively, non-significant (NS). The multivariate Cox proportional hazards model identified two variables significantly related to the primary outcome: male gender and defibrillation by a bystander. Among the 43 patients who died before 90 days, 28 died following withdrawal of life-sustaining therapy, as follows: 7/16 (43.8%), 10/13 (76.9%) and 11/14 (78.6%) of patients assigned to 32, 33 and 34 °C, respectively (trend test
p
 = 0.04). All levels of cooling were well tolerated.
Conclusions
There were no statistically significant differences in neurological outcomes among the different levels of TTM. However, future research should explore the efficacy of TTM at 32 °C.
Clinical trial registration
ClinicalTrials.gov unique identifier: NCT02035839 (
http://clinicaltrials.gov
).