Presentation Abstract

Session: LBCT.01-Acute Cardiovascular and Cerebrovascular Care
Presentation: Randomized Clinical Trial of Pre-hospital Induction of Mild Hypothermia in Out-of-Hospital Cardiac Arrest Patients Using a Rapid Infusion of 4oC Normal Saline
Pres Time: Sunday, Nov 17, 2013, 4:44 PM - 4:54 PM
Location: Hall E
Pres. Time: Sunday, Nov 17, 2013, 4:44 PM - 4:54 PM
Specialty: ReSS
Keywords: Cardiac arrest; Hypothermia; Ventricular fibrillation
Presenter: Francis Kim, Univ of Washington, Seattle, WA
Abstract: Background: In animal models of cardiac arrest, the benefit of therapeutic hypothermia declines when initiated more than 15 minutes after reperfusion. Although delayed hospital cooling has been demonstrated to improve outcome after cardiac arrest, pre-hospital cooling started immediately following return of spontaneous circulation may be more beneficial. The aims of this randomized clinical trial were to determine whether early in-field cooling improves survival and functional status in resuscitated cardiac arrest patients with ventricular fibrillation (VF) and without (non-VF).
Methods: In a prospective, randomized clinical trial, we assigned adults with out-of-hospital cardiac arrest to either rapid pre-hospital cooling with an infusion of up to 2 liters of 4oC normal saline as soon as possible following resuscitation or to standard care. Nearly all of the resuscitated VF patients admitted to the hospital received hospital cooling regardless of their randomization. The primary outcome was survival to hospital discharge and functional status at discharge.
Results: A total of 1359 patients (583 VF and 776 non-VF) were randomized to receive standard care with or without pre-hospital cooling. Among patients with VF, the intervention group had a mean core temperature decrease of 1.2 C +1.1 by hospital arrival, achieving a temperature of less than 34 C 1.3 hours sooner than the standard care group. Survival to hospital discharge was 62.5% in the intervention group vs. 64.3% in the control group, p=0.69. Among patients with non-VF, survival to discharge was 19.2% in the intervention group vs. 16.3% in the control group, p=0.3. Regardless of the initial rhythm, functional status at discharge was not significantly different between the treatment and control groups. The intervention was associated with increased incidence of re-arrest in the field (26% vs. 21%, p=0.007) as well as pulmonary edema on first chest x-ray and increased diuretic use, which all resolved within 12 hours after admission.
Although use of early, pre-hospital cooling reduced core temperature by hospital arrival and reduced the time to reach 34 C, it did not improve survival or functional status among patients resuscitated from out-of-hospital VF or non-VF.
Disclosures:  F. Kim: None. G. Nichol: None. C. Maynard: None. A. Hallstrom: None. P. Kudenchuk: None. T. Rea: None. M. Copass: None. D. Carlbom: None. S. Deem: None. W. Longstreth: None. M. Olsufka: None. L. Cobb: None.

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