• Circulation · Jul 2015

    Randomized Controlled Trial Comparative Study

    Endovascular Versus External Targeted Temperature Management for Patients With Out-of-Hospital Cardiac Arrest: A Randomized, Controlled Study.

    • Nicolas Deye, Alain Cariou, Patrick Girardie, Nicolas Pichon, Bruno Megarbane, Philippe Midez, Jean-Marie Tonnelier, Thierry Boulain, Hervé Outin, Arnaud Delahaye, Aurélie Cravoisy, Alain Mercat, Pascal Blanc, Charles Santré, Hervé Quintard, François Brivet, Julien Charpentier, Delphine Garrigue, Bruno Francois, Jean-Pierre Quenot, François Vincent, Pierre-Yves Gueugniaud, Jean-Paul Mira, Pierre Carli, Eric Vicaut, Frédéric J Baud, and Clinical and Economical Impact of Endovascular Cooling in the Management of Cardiac Arrest (ICEREA) Study Group.
    • From Réanimation Médicale Toxicologique, CHU Lariboisière, AP-HP, Paris, France (N.D., B.M., F.J.B.); Réanimation Médicale, CHU Cochin, AP-HP, Paris, France (A.C., J.C., J.-P.M.); Réanimation Polyvalente, CHU Salengro, Lille, France (P.G., D.G.); Réanimation Médico-Chirurgicale, CHU Dupuytren, Limoges, France (N.P., B.F.); Réanimation Médicale, CHU Minjoz, Besançon, France (P.M.); Réanimation Médicale, CHU La Cavale Blanche, Brest, France (J.-M.T.); Réanimation Polyvalente, CHR, Orléans, France (T.B.); Réanimation Médicale, CHI, Poissy, France (H.O.); Réanimation Polyvalente, CHR, Rodez, France (A.D.); Réanimation Médicale, CHU Central, Nancy, France (A.C.); Réanimation Médicale, CHU, Angers, France (A.M.); Réanimation Médicale, CHR Dubos, Pontoise, France (P.B.); Réanimation Polyvalente, CHR d'Annecy, Pringy, France (C.S.); Réanimation Médico-Chirurgicale, Hôpital Saint-Roch, Nice, France (H.Q.); Réanimation Médicale, CHU Béclère, AP-HP, Clamart, France (F.B.); Réanimation Médicale, Hôpital du Bocage, Dijon, France (J.-P.Q.); Réanimation Médico-Chirurgicale, Hôpital Avicenne, AP-HP, Bobigny, France (F.V.); Anesthésie-Réanimations-SAMU, CHU Lyon-Sud, Pierre-Bénite, France (P.-Y.G.); SAMU 75, CHU Necker, AP-HP, Paris, France (P.C.); and Unité Recherche Clinique, Hôpital Widal, AP-HP, Paris, France (E.V.). nicolas.deye@lrb.aphp.fr.
    • Circulation. 2015 Jul 21;132(3):182-93.

    BackgroundTargeted temperature management is recommended after out-of-hospital cardiac arrest. Whether advanced internal cooling is superior to basic external cooling remains unknown. The aim of this multicenter, controlled trial was to evaluate the benefit of endovascular versus basic surface cooling.Methods And ResultsInclusion criteria were the following: age of 18 to 79 years, out-of-hospital cardiac arrest related to a presumed cardiac cause, time to return of spontaneous circulation <60 minutes, delay between return of spontaneous circulation and inclusion <240 minutes, and unconscious patient after return of spontaneous circulation and before the start of cooling. Exclusion criteria were terminal disease, pregnancy, known coagulopathy, uncontrolled bleeding, temperature on admission <30°C, in-hospital cardiac arrest, immediate need for extracorporeal life support or hemodialysis. Patients were randomized between 2 cooling strategies: endovascular femoral devices (Icy catheter, Coolgard, Zoll, formerly Alsius; n=203) or basic external cooling using fans, a homemade tent, and ice packs (n=197). The primary end point, that is, favorable outcome evaluated by survival without major neurological damage (Cerebral Performance Categories 1-2) at day 28, was not significantly different between groups (odds ratio, 1.41; 95% confidence interval, 0.93-2.16; P=0.107). Improvement in favorable outcome at day 90 in favor of the endovascular group did not reach significance (odds ratio, 1.51; 95% confidence interval, 0.96-2.35; P=0.07). Time to target temperature (33°C) was significantly shorter and target hypothermia was more strictly maintained in the endovascular than in the surface group (P<0.001). Minor side effects directly related to the cooling method were observed more frequently in the endovascular group (P=0.009).ConclusionDespite better hypothermia induction and maintenance, endovascular cooling was not significantly superior to basic external cooling in terms of favorable outcome.Clinical Trial RegistrationURL: http://www.clinicaltrials.gov. Unique identifier: NCT00392639.© 2015 American Heart Association, Inc.

      Pubmed     Full text   Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…