The Effect of Pre-Hospital Cooling: Rather Worrying Results

JAMA just published another interesting puzzle piece on the topic of post arrest cooling. In this interesting, randomized trial, the authors addressed the question wether prehospital cooling aiming for 34°C improves outcomes after resuscitation from cardiac arrest in patients with ventricular fibrillation (VF) and non-VF. A total of 1359 patients were enrolled within 5 years. Primary outcomes were survival at hospital discharge and neurological status at discharge.

In regards of primary outcomes no differences were found between the intervention and control group. Also when looking at patients who awakened from coma or died without awakening again no significant differences between the intervention and control group were found. Also length of stay, access to early coronary angiography and reduction in level or withdrawal of life support did not differ.

When looking at patient safety issues though the investigators noted a higher incidence of rearrest during transport to the hospital. The intervention group (cooled out of hospital) also showed significantly lower oxygenation on arrival, increased pulmonary edema on the first chest x-ray and a greater use of diuretics during the first 12 hours after admission. During further hospitalization though the number of days ventilated, the incidence of re-intubation and the use of antibiotics did not differ.

The study results don’t support the practice of out-of-hospital cooling but show some worrying implications for patients safety.

Cobb LA et al. JAMA. 2013;311(1):45-52 

Open access on JAMA Network Reader (Need for sign up)

Recent BIJC blog on Targeted Temperature Management Trial: Targeted Temperature Management Trial: Is it Time to Stop Cooling Patients after Cardiac Arrest?

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