Therapeutic hypothermia after out-of-hospital cardiac arrest in Finnish intensive care units: the FINNRESUSCI study

Vaahersalo, Jukka; Hiltunen, Pamela; Tiainen, Marjaana; Oksanen, Tuomas; Kaukonen, Kirsi‐Maija; Kurola, Jouni; Ruokonen, Esko; Tenhunen, Jyrki; Ala‐Kokko, Tero; Lund, Vesa; Reinikainen, Matti; Kiviniemi, Outi; Silfvast, Tom; Kuisma, Markku; Varpula, Tero; Pettilä, Ville

doi:10.1007/s00134-013-2868-1

Cited by 137 publications

(101 citation statements)

References 36 publications

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“…The present study by Vaahersalo et al [3] adds further doubt to the field regarding the likely impact of TH in this subgroup. How could TH have a neutral effect on prognosis in these patients with non-shockable CA?…”

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confidence: 48%

“…those with multiple organ failure leading to early death). Finally, the two groups were small and not comparable [3]. Indeed the aetiologies of the OHCA were different, and the prolonged median time to ROSC in the 70 patients treated with TH (25 min) was significantly higher than in patients without TH.…”

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confidence: 86%

“…In this issue of the journal, Vaahersalo et al [3] report a large multicentre observational study, covering 98 % of the Finnish adult population, in which they prospectively evaluated over a 1-year period the post-resuscitation cares, the use of TH and the outcomes in all OHCA patients treated in the participating ICUs in Finland.…”

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confidence: 99%

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To cool or not to cool non-shockable cardiac arrest patients: it is time for randomized controlled trials

2013

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confidence: 48%

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To cool or not to cool non-shockable cardiac arrest patients: it is time for randomized controlled trials

2013

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“…Hemodialysis and male gender were associated with cooling success. Vaahersalo et al [54] evaluated postresuscitation care, implementation of TH, and outcomes of ICU-treated OOHCA patients admitted to 21 ICUs. Among 548 patients included in the study, 311 had a shockable rhythm and 237 had a non-shockable rhythm.…”

Section: Cardiac Arrestmentioning

confidence: 99%

Year in review in Intensive Care Medicine 2013: I. Acute kidney injury, ultrasound, hemodynamics, cardiac arrest, transfusion, neurocritical care, and nutrition

et al. 2013

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“…At that time, there were few data on the use of TH in comatose patients following cardiac arrest from other rhythms or after in-hospital cardiac arrest (IHCA), but the ILCOR advisory statement indicated that TH might also be beneficial under such circumstances. Since then, several observational studies with historical or concurrent control groups have shown benefit after cooling in comatose survivors after OHCA from non-shockable rhythms [14], although such studies carry risk of bias, and some observational studies have shown no benefit for TH after cardiac arrest from nonshockable rhythms [15]. Contrary to the prevailing opinion several years ago, mild hypothermia may also be beneficial in the presence of cardiogenic shock: in a case series of 14 such patients, cooling improved cardiac index, stroke volume and mean arterial blood pressure [16].…”

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confidence: 99%

Therapeutic hypothermia and coronary angiography are mandatory after out-of-hospital cardiac arrest: Yes

Nolan

Cariou

2014

Intensive Care Med

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Finding the cause of out-of-hospital cardiac arrest (OHCA) is generally considered to be useful in order to prevent recurrence and subsequent clinical deterioration. As acute coronary syndrome (ACS) is a frequent cause of OHCA, several experts claim that resuscitated patients of presumed cardiac cause should undergo immediate coronary angiography with subsequent percutaneous coronary intervention (PCI) if indicated, regardless of clinical symptoms and/or electrocardiogram (ECG) criteria [1]. This strategy is supported by several strong arguments. First, there is a very high prevalence of coronary lesions in these arrest patients. In a recent metaanalysis, the prevalence of significant coronary artery disease ranged from 59 to 71 % in patients without an obvious non-cardiac aetiology (Table 1) [2]. This high prevalence of recent coronary occlusion provides a strong rationale for performing coronary angiography in OHCA patients with no obvious extra-cardiac cause, in order to detect the culprit lesion. Second, early coronary angiography also enables immediate PCI, when indicated. Since the publication of the pioneering study by Spaulding and co-workers in 1997 [3], many observational studies have reported the feasibility and possible survival benefit from an early invasive approach. In a cohort of 435 OHCA patients without obvious extra-cardiac cause, successful PCI was an independent factor for survival, regardless of the post-resuscitation ECG findings (odds ratio (OR) 2.1 [95 % confidence interval (CI) 1.2-3.7]) [4]. In this issue, Bougouin and colleagues [5] report on the characteristics of 3,816 cases of treated OHCA in Paris; after adjustment for other prognostic factors, coronary angiography was associated with survival (OR 2.4, 95 % CI 1.4-4.0, P = 0.001). As the data are derived from a 'real-life', large, population-based registry, this result underlines that the benefit of early reperfusion is not restricted to specialised 'cardiac arrest centres'. Finally early PCI is also associated with a better long-term outcome: among 1,001 OHCA survivors discharged from hospital in the USA, Dumas and associates reported a 5-year survival of 78.7 % in those treated with PCI compared with 54.4 % in those not treated with PCI (p \ 0.01). Moreover, PCI was associated with a lower risk of death after adjustment for confounders (hazard ratio 0.56 [95 % CI 0.34, 0.61], p \ 0.01) [6]. The benefit of early revascularization may not be restricted to crude survival but could also be associated with an improved quality of life. Specifically focusing on quality of life, daily functioning and participation in social activities, in a long-term follow-up of 63 OHCA survivors (after a mean follow-up of 36 ± 18.8 months) PCI was associated with better cognitive function, participation in social activities and instrumental daily activities compared with patients not treated with PCI [7]. Even in the absence of large randomised studies, it is highly probable that early coronary revascularisation, when required, is associated with a c...

show abstract

Therapeutic hypothermia after out-of-hospital cardiac arrest in Finnish intensive care units: the FINNRESUSCI study

Abstract: One-year unfavourable neurological outcome of patients with shockable rhythms after TH was lower than in previous randomized controlled trials. However, our results do not support use of TH in patients with non-shockable rhythms.

Cited by 137 publications

References 36 publications

To cool or not to cool non-shockable cardiac arrest patients: it is time for randomized controlled trials

To cool or not to cool non-shockable cardiac arrest patients: it is time for randomized controlled trials

Year in review in Intensive Care Medicine 2013: I. Acute kidney injury, ultrasound, hemodynamics, cardiac arrest, transfusion, neurocritical care, and nutrition

Therapeutic hypothermia and coronary angiography are mandatory after out-of-hospital cardiac arrest: Yes

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