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Hypothermia versus Normothermia after Out-of-Hospital Cardiac Arrest

By Currents Editor posted 08-06-2021 11:38

  

Hypothermia versus Normothermia after Out-of-Hospital Cardiac Arrest

New England Journal of Medicine (07/17/21) Vol. 384, No. 24, P. 2283, DOI: 10.1056/NEJMoa2100591

Dankiewicz, Josef; Cronberg, Tobias; Lilja, Gisela; et al. 

For unconscious patients after out-of-hospital cardiac arrest, targeted hypothermia did not reduce mortality at 6 months compared with targeted normothermia, new research shows. The findings run counter to practice-changing trials published in 2002 that reported the benefits of hypothermia in this setting. In the new Targeted Hypothermia versus Targeted Normothermia after Out-of-Hospital Cardiac Arrest (TTM2) trial, researchers evaluated the beneficial and harmful effects of hypothermia compared with normothermia and early treatment of fever in patients following cardiac arrest. Adults with coma who had experienced an out-of-hospital cardiac arrest of presumed cardiac or unknown cause were randomized to undergo targeted hypothermia at 33°C and then controlled rewarming, or targeted normothermia with early treatment of fever (body temperature, ≥37.8°C). The primary outcome — death from any cause at 6 months — was seen in 50% (465) of 925 patients in the hypothermia group and 48% (446) of 925 patients in the normothermia group. Additionally, 55% (488 of 881) of patients in the hypothermia group and 55% (479 of 866) of the normothermia group had moderately severe disability or worse, with a modified Rankin scale score of ≥4. There was no significant difference in most adverse events between the two groups, although arrhythmias causing hemodynamic compromise were more common in the hypothermia group compared with the normothermia group.

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