Effect of intra-arrest trans-nasal evaporative cooling in out-of-hospital cardiac arrest: a pooled individual participant data analysis.

Critical Care : the Official Journal of the Critical Care Forum
Fabio TacconePRINCESS investigators

Abstract

Randomized trials have shown that trans-nasal evaporative cooling initiated during CPR (i.e. intra-arrest) effectively lower core body temperature in out-of-hospital cardiac arrest patients. However, these trials may have been underpowered to detect significant differences in neurologic outcome, especially in patients with initial shockable rhythm. We conducted a post hoc pooled analysis of individual data from two randomized trials including 851 patients who eventually received the allocated intervention and with available outcome ("as-treated" analysis). Primary outcome was survival with favourable neurological outcome at hospital discharge (Cerebral Performance Category [CPC] of 1-2) according to the initial rhythm (shockable vs. non-shockable). Secondary outcomes included complete neurological recovery (CPC 1) at hospital discharge. Among the 325 patients with initial shockable rhythms, favourable neurological outcome was observed in 54/158 (34.2%) patients in the intervention and 40/167 (24.0%) in the control group (RR 1.43 [confidence intervals, CIs 1.01-2.02]). Complete neurological recovery was observed in 40/158 (25.3%) in the intervention and 27/167 (16.2%) in the control group (RR 1.57 [CIs 1.01-2.42]). Among the 526...Continue Reading

References

Feb 22, 2002·The New England Journal of Medicine·UNKNOWN Hypothermia after Cardiac Arrest Study Group
Feb 22, 2002·The New England Journal of Medicine·Stephen A BernardKaren Smith
May 3, 2003·American Journal of Epidemiology·Tauqir Y GorayaVéronique L Roger
Jul 16, 2003·Resuscitation·Jerry P NolanUNKNOWN Advancement Life support Task Force of the International Liaison committee on Resuscitation
Jul 22, 2015·JAMA : the Journal of the American Medical Association·Carolina Malta HansenChristopher B Granger
Oct 1, 2015·BioMed Research International·Ketki D RainaClifton W Callaway
Jul 26, 2017·JAMA : the Journal of the American Medical Association·Hans KirkegaardMarkus B Skrifvars
Mar 5, 2019·Resuscitation·Holger GässlerMatthias Helm
Oct 3, 2019·The New England Journal of Medicine·Jean-Baptiste LascarrouUNKNOWN CRICS-TRIGGERSEP Group
Mar 10, 2020·Nephrology·Giovanni TripepiKitty J Jager

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