Therapeutic hypothermia after cardiac arrest: A retrospective comparison of surface and endovascular cooling techniques

Michael A. Gillies*, Rosalie Pratt, Craig Whiteley, Jamie Borg, Richard J. Beale, Shane Tibby

*Corresponding author for this work

    Research output: Contribution to journalArticlepeer-review

    97 Citations (Scopus)

    Abstract

    Objectives: Therapeutic hypothermia (32-34 degrees C) is recommended for comatose survivors of cardiac arrest; however, the optimal technique for cooling is unknown. We aimed to compare therapeutic hypothermia using either surface or endovascular techniques in terms of efficacy, complications and outcome.

    Design: Retrospective cohort study.

    Setting: Thirty-bed teaching hospital intensive care unit (ICU).

    Patients: All patients (n = 83) undergoing therapeutic hypothermia following cardiac arrest over a 2.5-year period. The mean age was 61 +/- 16 years; 88% of arrests occurred out of hospital, and 64% were ventricular fibrillation/tachycardia.

    Interventions: Therapeutic hypothermia was initiated in the ICU using iced Hartmann's solution, followed by either surface (n = 41) or endovascular (n = 42) cooling; choice of technique was based upon endovascular device availability. The target temperature was 32-34 degrees C for 12-24h, followed by rewarming at a rate of 0.25 degrees C h(-1).

    Measurements and main results: Endovascular cooling provided a longer time within the target temperature range (p = 0.02), less temperature fluctuation (p = 0.003), better control during rewarming (0.04), and a lower 48-h temperature load (p = 0.008). Endovascular cooling also produced less cooling-associated complications in terms of both overcooling (p = 0.05) and failure to reach the target temperature (p = 0.04). After adjustment for known confounders, there were no differences in outcome between the groups in terms of ICU or hospital mortality, ventilator free days and neurological outcome. Conclusion: Endovascular cooling provides better temperature management than surface cooling, as well as a more favorable complication profile. The equivalence in outcome suggested by this small study requires confirmation in a randomized trial.

    Original languageEnglish
    Pages (from-to)1117-1122
    Number of pages6
    JournalResuscitation
    Volume81
    Issue number9
    DOIs
    Publication statusPublished - Sept 2010

    Keywords

    • Critical care
    • Hypothermia
    • Cardiac arrest
    • INTENSIVE-CARE-UNIT
    • MILD INDUCED HYPOTHERMIA
    • SAFETY
    • EFFICACY
    • ADMISSION
    • MODELS

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