Saturday, October 21, 2006

hypothermia after arrest

Bernard et al. Treatment of comatose survivors of our of hospital cardiac arrest with induced hypothermia. NEJM 2002 346:557-63 (Australia) Study done 1996-1999. Candidates men>18, women >50, v fib, coma, cardiogenic shock (BP<90 despite pressors). Basic cooling in ambulance, core cooling in ER to 33 degrees, usual measueres used eg. heparin tpa, lidocaine, versed, pancuronium. Life support withdrawn at 72 hours. n=77 patients, 39/43 assigned to hypothermia received it. 21/43 patients assigned to hypothermia had a good outcome, 9/34 in normothermia group (49 v. 26 %)defined as discharge home or to rehab. Normal disability was achieved in 15 v 7 patients (35 v 21 %). Mortality (51 v. 68 % ) did not reach significance. Factors affecting outcome included age (two years led to 9 % less chance of good outcome)and time till return of circulation also was important.

Paper 2: Hypothermia study group. Mild therapeutix hypothermia to improve the neurologic outcome after cardiac arrest. NEJM 346:549-556. (Austria). Primary endpoint is favorable neurologic outcome at 6 months by Pittsburgh cerebral performance (1 good recover, 2, mod disability, 3 severe disability, 4 veg, 5 death). Criteria: witnessed arrest, VF, no hypotension, comatose. 1996-2001. 275/35551 patients enrolled. 137 to hypothermia group, 138 to control. Of treated group, 75/136 (55%) had good outcome v. 54/137 (39 %) NTT to get one additional good outcome = 6. Death was less in treated group: NTT=7.