Duration of Device-Based Fever Prevention After Cardiac Arrest
Published on: May 11, 2023
Comatose patients who survived an out-of-hospital cardiac arrest had similar rates of mortality or severe disability and coma with active device-based fever prevention for 36 or 72 hours, according to new research. International guidelines recommend active fever prevention for 72 hours in comatose patients following cardiac arrest, but there is little data from randomized clinical trials of the intervention. For this study, comatose patients who had been resuscitated following an out-of-hospital cardiac arrest were randomized to receive device-based temperature control targeting 36°C for 24 hours, followed by targeting of 37°C for 12 or 48 hours, for a total of 36 or 72 hours, or until consciousness returned. In all, the 36-hour temperature control group included 393 patients and the 72-hour temperature control group included 396 patients. At 90 days, a primary endpoint event – a composite of death from any cause or hospital discharge with a Cerebral Performance Category of 3-4 – occurred in 32.3% (127/393) of the 36-hour group and 33.6% (133/396) of the 72-hour group. Mortality in the two groups was 29.5% and 30.3%, respectively. The median Montreal Cognitive Assessment score at 90 days – a secondary outcome – was 26 in the 36-hour group and 27 in the 72-hour group. The most commonly reported adverse events were infection, bleeding, and seizure; however, the incidence of adverse events did not vary significantly between the two groups. The lack of a significant difference between the two durations in terms of mortality and severe disability or coma were consistent across all prespecified subgroups, including older individuals and those with coexisting medical conditions.