Prehospital Induction of Mild Hypothermia in Adults With Car
Prehospital Induction of Mild Hypothermia in Adults With Cardiac Arrest
Patient / Population Intervention / Exposition Comparaison Critère de jugement
In 1359 adults with ROSC after out-of-hospital cardiac arrest, prehospital cold saline did not improve survival or neurologic recovery versus standard care.
N
1 359
Schéma
Randomized, unblinded clinical trial in a single EMS system (King County, Washington). 1359 adults resuscitated from out-of-hospital cardiac arrest were randomized after ROSC to prehospital infusion of up to 2 L of 4°C normal saline plus standard care or to standard care alone, with pre-specified separate analysis of the ventricular fibrillation (n=583) and non-VF (n=776) strata; both groups were eligible for in-hospital cooling.
Critère
Survival to hospital discharge and neurological status at discharge (full recovery or mild impairment), each reported separately for the VF and non-VF strata.
RésultatPrehospital cooling lowered mean core temperature at hospital arrival by 1.20°C (95% CI −1.33 to −1.07) in VF and 1.30°C (95% CI −1.40 to −1.20) in non-VF patients and shortened time to <34°C by about 1 hour, but did not change survival to discharge in VF (62.7% vs 64.3%; P=.69) or non-VF patients (19.2% vs 16.3%; P=.30), nor full recovery or mild impairment at discharge in VF (57.5% vs 61.9%; P=.69) or non-VF patients (14.4% vs 13.4%; P=.30). Rearrest in the field was more frequent with the intervention (26% vs 21%; P=.008; NNH about 20), along with more diuretic use and more pulmonary edema on the first chest radiograph, which resolved within 24 hours of admission.
Kim F, Nichol G, Maynard C, et al. Effect of prehospital induction of mild hypothermia on survival and neurological status among adults with cardiac arrest: a randomized clinical trial. JAMA. 2014;311(1):45-52. 10.1001/jama.2013.282173