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

Lopez-de-Sa, Esteban; Juárez, Míriam; Armada, Eduardo; Sánchez‐Salado, José Carlos; Sánchez, Pedro L.; Loma-Osorio, Pablo; Sionís, Alessandro; Monedero, María Carmen; Martínez‐Sellés, Manuel; Martín-Benítez, Juan Carlos; Ariza, Albert; Uribarri, Aitor; Acuña, José María García; Villa, P.; Pérez, Pablo Jorge; Storm, Christian; Dee, Anne; López‐Sendón, José

doi:10.1007/s00134-018-5256-z

Cited by 52 publications

(32 citation statements)

References 23 publications

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“…TTM should be started immediately at ICU admission [ 62 ]. However, the optimal target temperature [ 63 , 64 ], the optimal duration [ 65 ] of TTM as well as the cooling procedures [ 66 – 68 ] are still matter of debate.…”

Section: Management Of Post-resuscitation Shockmentioning

confidence: 99%

Post-resuscitation shock: recent advances in pathophysiology and treatment

Jozwiak

Bougouin

Géri

et al. 2020

Ann. Intensive Care

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A post-resuscitation shock occurs in 50–70% of patients who had a cardiac arrest. It is an early and transient complication of the post-resuscitation phase, which frequently leads to multiple-organ failure and high mortality. The pathophysiology of post-resuscitation shock is complex and results from the whole-body ischemia–reperfusion process provoked by the sequence of circulatory arrest, resuscitation manoeuvers and return of spontaneous circulation, combining a myocardial dysfunction and sepsis features, such as vasoplegia, hypovolemia and endothelial dysfunction. Similarly to septic shock, the hemodynamic management of post-resuscitation shock is based on an early and aggressive hemodynamic management, including fluid administration, vasopressors and/or inotropes. Norepinephrine should be considered as the first-line vasopressor in order to avoid arrhythmogenic effects of other catecholamines and dobutamine is the most established inotrope in this situation. Importantly, the optimal mean arterial pressure target during the post-resuscitation shock still remains unknown and may probably vary according to patients. Mechanical circulatory support by extracorporeal membrane oxygenation can be necessary in the most severe patients, when the neurological prognosis is assumed to be favourable. Other symptomatic treatments include protective lung ventilation with a target of normoxia and normocapnia and targeted temperature management by avoiding the lowest temperature targets. Early coronary angiogram and coronary reperfusion must be considered in ST-elevation myocardial infarction (STEMI) patients with preserved neurological prognosis although the timing of coronary angiogram in non-STEMI patients is still a matter of debate. Further clinical research is needed in order to explore new therapeutic opportunities regarding inflammatory, hormonal and vascular dysfunction.

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Section: Management Of Post-resuscitation Shockmentioning

confidence: 99%

Post-resuscitation shock: recent advances in pathophysiology and treatment

Jozwiak

Bougouin

Géri

et al. 2020

Ann. Intensive Care

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“…Vadeboncoeur et al [10] indicated that CAG patients were more likely to be treated with targeted temperature management (TTM), suggesting a higher intensity of care. Although some studies showed no advantage for TTM of 33℃in comparison with TTM of 36℃, they didn't rule out the bene t of TTM [13,14]. These may explain why early CAG is bene cial for the survival.…”

Section: Discussionmentioning

confidence: 94%

Early coronary angiography and percutaneous coronary intervention for out of hospital cardiac arrest survivors without ST-segment elevation: a systematic review and meta-analysis

Huang¹,

Liu²,

Guo

et al. 2020

Preprint

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Objective: The meta-analysis aims to identify whether out of hospital cardiac arrest (OHCA) survivors of non ST-segment elevation (NSTE) can benefit from early coronary angiography (CAG) and percutaneous coronary intervention (PCI).Methods: The relevant studies from MEDLINE, Cochrane Library, Embase were searched by two independent investigators using a variety of keywords. Stata software (version 12.0, Stata Corp LP, College Station, TX, USA) was used for statistical analysis. Results: A total of 12 studies (9 observational studies, 1 cohort study and 2 randomized control trials) were identified and incorporated into the meta-analysis. For overall analysis, the strategy of early angiography was associated with decreased short-term (hospital discharged) mortality (RR=0.72, 95% CI=0.56-0.93, P=0.000) and long-term (follow up) mortality (RR=0.84, 95% CI=0.71-0.99, P=0.007). However, when analyzed in the subgroup of randomized controlled study, the strategy of early angiography didn’t have survival benefit in the randomized controlled study group for short-term mortality (RR=1.12, 95% CI=0.89-1.41, P=0.331) and long-term mortality (RR=1.06, 95% CI=0.85-1.32, P=0.572). Meanwhile, our analysis found that, if early CAG performed, PCI followed by CAG is not associated with hospital discharged mortality (RR=1.14, 95% CI=0.96-1.37, P=0.132) compared with CAG alone. No significant differences between the groups were found in the remaining secondary endpoints.Conclusion: Due to the observational nature of the studies available, we may consider that early CAG and PCI is not be recommended for patients with NSTE OHCA.

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“…A recent multicentre pilot randomised clinical trial (RCT) assigned comatose survivors of witnessed out-of-hospital CA (OHCA) from ventricular fibrillation/ventricular tachycardia (VF/VT) to TTM at 32 °C (n = 52), 33 °C (n = 49) or 34 °C (n = 49), see Table 1. Cooling was tolerated well, but 90-day neurological outcome did not differ among groups [4]. Patients cooled to 32 °C had lower rates of WLST due to severe HIBI.…”

Section: Temperature Management and Coronary Angiographymentioning

confidence: 87%