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Duration of Device-Based Fever Prevention after Cardiac Arrest

By Currents Editor posted 11-21-2022 23:00


New England Journal of Medicine (11/06/22) DOI: 10.1056/NEJMoa2212528

Hassager, Christian; Schmidt, Henrik; Møller, Jacob E.; et al.

New research out of Denmark evaluated two methods of device-based fever prevention in comatose adult patients who had been resuscitated after an out-of-hospital cardiac arrest. For the study, 393 patients were randomized to device-based temperature control targeting 36°C for 24 hours, followed by targeting of 37°C for 12 hours (36 hours total), or until the patient regained consciousness. Another 396 patients were randomly assigned to the same initial regimen, followed by targeting of 37°C for 48 hours (72 hours total). During the first 24 hours of targeted temperature management and in the subsequent rewarming period, all of the patients received mechanical ventilation and were sedated to a Richmond Agitation–Sedation Scale score of −4. Three months post-randomization, a primary endpoint event — a composite of death from any cause or hospital discharge with a Cerebral Performance Category of 3 or 4 — had occurred in 32.3% (127) of the 36-hour group and in 33.6% (133) of the 72-hour group. Rates of mortality were 29.5% and 30.3%, respectively. The median Montreal Cognitive Assessment scores were 26 and 27, respectively, at 90 days. The incidence of adverse events did not differ significantly between the two groups. The authors concluded that "active device-based fever prevention for 72 hours or 36 hours after cardiac arrest did not result in significantly different percentages of patients dying or having severe disability or coma."


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