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

TY - JOUR

T1 - Therapeutic hypothermia after cardiac arrest

T2 - A retrospective comparison of surface and endovascular cooling techniques

AU - Gillies, Michael A.

AU - Pratt, Rosalie

AU - Whiteley, Craig

AU - Borg, Jamie

AU - Beale, Richard J.

AU - Tibby, Shane

PY - 2010/9

Y1 - 2010/9

N2 - 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.

AB - 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.

KW - Critical care

KW - Hypothermia

KW - Cardiac arrest

KW - INTENSIVE-CARE-UNIT

KW - MILD INDUCED HYPOTHERMIA

KW - SAFETY

KW - EFFICACY

KW - ADMISSION

KW - MODELS

U2 - 10.1016/j.resuscitation.2010.05.001

DO - 10.1016/j.resuscitation.2010.05.001

M3 - Article

SN - 0300-9572

VL - 81

SP - 1117

EP - 1122

JO - Resuscitation

JF - Resuscitation

IS - 9

ER -