Eddy S. Lang, MD
What is the effectiveness of therapeutic hypothermia in adults surviving cardiac arrest?
Included studies compared therapeutic hypothermia (target body temperature < 35°C), applied within 6 hours of arrival at hospital, with standard treatment in adults who had cardiac arrest and were successfully resuscitated. Outcomes included good neurologic recovery (best cerebral performance category of 1 or 2 or as defined by author), survival to hospital discharge, survival and quality of life at 6 months and ≥ 1 year, dependence, and cost-effectiveness.
MEDLINE, EMBASE/Excerpta Medica, CINAHL, PASCAL, and BIOSIS (to Jan 2007); Cochrane Central Register of Controlled Trials (Issue 1, 2007); and reference lists were searched for randomized and quasi-randomized controlled trials. Experts were contacted. 5 trials (n = 479) met the selection criteria. 3 trials (n = 383, mean age 59 to 72 y, 61% to 76% men) used conventional cooling methods (e.g., cooling packs placed around the head, neck, torso, and limbs), 1 used hemofiltration, and 1 used an unknown method. 3 trials were of good quality.
Meta-analysis of 5 trials showed that therapeutic hypothermia improved neurologic outcome (Table). Meta-analysis of individual patient data from 3 trials that used conventional cooling methods showed improved neurologic outcome and survival to discharge (Table). 1 study that used hemofiltration for cooling found no difference between groups for good neurologic outcome or survival to discharge. No data were available on survival at 1 year, quality of life, dependence, or cost-effectiveness.
In adults who survive cardiac arrest, therapeutic hypothermia after cardiopulmonary resuscitation improves neurologic outcome and survival to discharge.
Therapeutic hypothermia vs control in adults after cardiac arrest*
*Abbreviations defined in Glossary. RBI, NNT, and CI calculated from data in article using a fixed-effect model.
†Individual patient data analysis.
Lang ES. Review: Therapeutic hypothermia improves neurologic outcome and survival to discharge after cardiac arrest. Ann Intern Med. ;152:JC2–2. doi: 10.7326/0003-4819-152-4-201002160-02002
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Published: Ann Intern Med. 2010;152(4):JC2-2.
Cardiology, Emergency Medicine, Rhythm Disorders and Devices.
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