HACA-IHCA

Hypothermia After In-Hospital Cardiac Arrest

Patient / Population Intervention / Exposition Vergleich Endpunkt

In 249 comatose adults resuscitated after in-hospital cardiac arrest, hypothermia at 32-34°C did not reduce 180-day mortality compared with normothermia.

249

Design

Investigator-initiated, open-label, blinded-outcome-assessor, multicenter randomized controlled trial in 11 German hospitals; comatose adults with ROSC after in-hospital cardiac arrest randomized 1:1 to hypothermic temperature control at 32-34°C for 24 h with slow rewarming versus normothermia (fever prevention, target <37.5°C); 1055 screened April 3, 2007 to May 1, 2014, 249 randomized, 238 in the primary analysis; planned 220 per group (440 total) but terminated early for futility after an unplanned interim analysis at 50% accrual.

Endpunkt

Primary: all-cause mortality at 180 days. Secondary: in-hospital mortality and favorable functional outcome (Cerebral Performance Category 1-2) at 180 days.

Ergebnis180-day mortality 72.5% (87/120) with hypothermia versus 71.2% (84/118) with normothermia (RR 1.03, 95% CI 0.79-1.40; p=0.822). In-hospital mortality 62.5% versus 57.6% (RR 1.11, 95% CI 0.86-1.46; p=0.443); favorable functional outcome 22.5% versus 23.7% (RR 1.04, 95% CI 0.78-1.44; p=0.822); no difference in ICU stay (median 7 versus 8 days, p=0.584) or hospital stay (11 versus 13 days, p=0.164). Mean age 72.6±10.4 years, 64% male; temperature <34°C reached in 72.4% within 4.2±2.8 h, mean temperature over the first 12 h 34.0±1.3°C in the hypothermia arm.

Wolfrum S, Roedl K, Hanebutte A, et al. Temperature Control After In-Hospital Cardiac Arrest: A Randomized Clinical Trial. Circulation. 2022;146(18):1357-1366. 10.1161/circulationaha.122.060106