The trial aimed to assess the safety and effectiveness of moderate (target temperature of 31°C) against mild (target temperature of 34°C) temperature therapy in comatose survivors having out-of-hospital cardiac arrest (OOHCA). The participants were assigned to moderate hypothermia or mild hypothermia groups equally. The stratification of the study was based on initial rhythm (ventricular tachycardia or ventricular fibrillation [VT/VF] compared to non-VT/VF). Overall, 389 participants were enrolled, 196 in the mild hypothermia group and 193 in the moderate hypothermia group. The follow-up duration of the study was 180 days. 

The target temperature was attained through rewarming, and cooling was achieved through an endovascular cooling device. OOCHA patients and unconscious with a Glasgow Coma Score of £8 were included in the study while excluding patients with severe complications or in a coma due to reasons other than cardiac arrest. The other characteristics of the study are as follows: 

  1. ST-segment elevation myocardial infarction (STEMI) in 38%.

  2. Initial shockable rhythm in 86%

  3. Bystander CPR in 76%.

  4. Percutaneous coronary intervention was done in 58%; coronary angiography was performed in 97%. 

  5. Spontaneous circulation’s arrest to return time- 22 minutes.

Findings:

The primary findings for moderate vs. mild hypothermia were found at 180 days was 48.4% vs. 45.4% for death or poor neurological outcome. At the same time, the secondary outcomes noted for the moderate vs. mild hypothermia group are mentioned below.

  1. Pneumonia- 67.4% vs. 63.4%

  2. Seizure- 12.5% vs. 7.1%

  3. Thrombolysis in myocardial infarction major bleed- 23.4% vs. 19.7%

  4. Modified ranking scale score between 4-6 at follow-up- 46% vs. 44%

  5. Renal replacement therapy requirement- 9.2% vs. 9.3%

  6. Cardiac intensive care unit (ICU) stay: 10 days vs. 7 days 

Conclusion:

In improving neurological outcomes or mortality, moderate hypothermia of target temperature 31°C has no superiority over mild hypothermia of target temperature 34°C among comatose OOHCA patients at six months.

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Keywords

Disease Condition,Arrhythmias,Ventricular Tachycardia

Source

https://www.acc.org/latest-in-cardiology/clinical-trials/2021/05/14/22/33/capital-chill