Induction of Therapeutic Hypothermia During Out-of-Hospital Cardiac Arrest Using a Rapid Infusion of Cold Saline

Bernard, Stephen; Smith, Karen; Finn, Judith; Hein, Cindy; Grantham, Hugh; Bray, Janet; Deasy, Conor; Stephenson, Michael; Williams, Teresa A.; Straney, Lahn; Brink, Deon; Larsen, Richard E; Cotton, C. Randy; Cameron, Peter

doi:10.1161/circulationaha.116.021989

Cited by 136 publications

(131 citation statements)

References 23 publications

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“…The trial showed no difference in the primary outcomes of survival and neurological status at hospital discharge, but detected more episodes of re-arrest (26% vs 21%) and pulmonary edema on first chest x-ray (41% vs 30%) among patients in the prehospital cooling group. A recent RCT from Australia randomized 1198 patients to usual care or prehospital cooling by infusion of up to 2 L of cold saline (mean 1193 ml) initiated during the delivery of CPR [32]. This trial was stopped early due to concerns that TTM management in receiving hospitals had changed following publication of the Nielsen TTM trial [28]; no differences were observed in the primary outcome of survival at hospital discharge.…”

Section: Discussionmentioning

confidence: 99%

Prehospital cooling to improve successful targeted temperature management after cardiac arrest: A randomized controlled trial

et al. 2017

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Section: Discussionmentioning

confidence: 99%

Prehospital cooling to improve successful targeted temperature management after cardiac arrest: A randomized controlled trial

et al. 2017

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“…In recent years there is a greater use of intranasal cooling, although mostly in combination with other methods: the only found studies in which this method is used alone are Castren [24] (without significant difference in mortality) and Belohlavek [31] (without significant differences in neurological prognosis). No significant differences were found either in mortality -RR 1.01 (0.97 -1.04) -nor in neurological prognosis -RR 1.01 (0.75 -1.35) -in the studies that perform intra-CA cooling [30,33,34]. The evaluation of the methodological quality of the studies provides surprising data.…”

Section: Resultsmentioning

confidence: 98%

Benefit Absence of Therapeutic Moderate Hypothermia in the Treatment of Cardiac Arrest: A Systematic Review and Meta-Analysis

Ángel¹

2018

CCR

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Background: Hyperthermia is frequent after cardiac arrest, and is associated with poor vital and neurological prognosis. In the last few years there have been published some studies that show benefits with moderate hypothermia in these patients, and other studies haven´t shown such benefits. Aim: To collect all clinical trials evaluating the utility of moderate therapeutic hypothermia in survivors of a cardiac arrest. Method: A comprehensive search of clinical trials evaluating moderate hypothermia in patients who survive a cardiac arrest was carried out. The mortality and quality of life of the survivors were evaluated. The quality of the included studies, the publication bias and the heterogeneity of the results were evaluated. Results: there is no significant reduction in mortality (RR 0.97, 95% CI 0.93-1.01) or increase in quality of life (RR 1.07, 95% CI 0.94-1.21) of the patients undergoing moderate hypothermia versus those not treated with that. There are no different results in patients with cardiac arrest with defibrillable and non -defibrillable rhythms, with the different used cooling methods, or even with the induction of intra -cardiac arrest hypothermia. The mortality of these patients is high, and there are no significant differences in relation to the age or sex of them. Conclusion: In patients who survive a cardiac arrest, the induction of moderate hypothermia is not recommended.

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“…Six studies investigated therapeutic hypothermia (TH) (21)(22)(23)(24)(25)(26), initiated in the post-arrest phase in three of the studies (21)(22)(23), in the intra-arrest phase in two (24,26) and in either phase in one (25). None of these studies reported significant findings in survival to hospital discharge to support or refute therapeutic hypothermia (Figure 1).…”

Section: Application Of Therapeutic Hypothermiamentioning

confidence: 99%

Strategies to Improve Out-of-Hospital Cardiac Arrest Outcomes in the Pre-Hospital Environment – Part B: Non-Pharmaceutical Strategies

Pemberton¹,

Franklin²,

Watt³

2019

Australasian Journal of Paramedicine

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IntroductionOut-of-hospital cardiac arrest (OHCA) historically has low survival rates. Higher rates of survival have recently developed in some small geographical areas, which pre-empted an increase in the volume of research in this field. The aim of this paper is to consolidate the findings of the strategies that do not focus on drugs.MethodsThis is a systematic search and review, rather than a systematic review. A search of four databases (MEDLINE, CINAHL, Informit, Scopus) was undertaken in February 2017. Papers published between 2007 and 2017 containing strategies that may be used by paramedics when resuscitating adult patients in OHCA from presumed cardiac aetiology were identified.ResultsTwenty-eight studies were included in the review, comprising six separate strategies. This manuscript reports on the four non-pharmaceutical strategies (use of a modified resuscitation protocol; use of a mechanical chest compression device; intra-thoracic pressure regulation and application of therapeutic hypothermia).ConclusionUse of a modified resuscitation protocol to improve the quality of cardiopulmonary resuscitation, was the only strategy showing evidence to warrant a recommendation for immediate implementation. Future studies should focus on strategy specific patient subsets.

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Induction of Therapeutic Hypothermia During Out-of-Hospital Cardiac Arrest Using a Rapid Infusion of Cold Saline

Abstract: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01173393.

Cited by 136 publications

References 23 publications

Prehospital cooling to improve successful targeted temperature management after cardiac arrest: A randomized controlled trial

Prehospital cooling to improve successful targeted temperature management after cardiac arrest: A randomized controlled trial

Benefit Absence of Therapeutic Moderate Hypothermia in the Treatment of Cardiac Arrest: A Systematic Review and Meta-Analysis

Strategies to Improve Out-of-Hospital Cardiac Arrest Outcomes in the Pre-Hospital Environment – Part B: Non-Pharmaceutical Strategies

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