Is There Any Benefit at all to Hypothermia in In-Hospital Cardiac Arrest

Data from a large cohort examining the the benefit of hypothermia in adult in- hospital arrest found no benefit. As a matter of TTM( targeted temperature management) was associated with a lower likelihood of survival to hospital discharge and a lower likelihood of a favorable neurological outcome in both shockable and non- shockable rhythms . An RCT is certainly warranted in this group. The data are consistent with a prospective study in the pediatric population ( the latter did have a major flaw of initiating TTM on average 5 hours after ROSC )

Association Between Therapeutic Hypothermia and Survival After In-Hospital Cardiac Arrest

No Benefit from Therapeutic Cooling After Pediatric In-Hospital Cardiac Arrest

One-year outcomes were similar with therapeutic hypothermia or therapeutic normothermia.

The efficacy of therapeutic hypothermia (target temperature, 33.0°C) versus therapeutic normothermia (target temp 36.8°C) in improving outcomes after out-of-hospital cardiac arrest in children is similar in clinical trials. To compare the efficacy of these interventions after in-hospital pediatric cardiac arrest, researchers randomized 329 children aged 48 hours to 18 years to either intervention (maintained for 120 hours) after in-hospital arrest.

The primary outcome was 12-month survival with favorable neurobehavioral outcomes. All participants had previously normal neurobehavioral assessment, received chest compressions for at least 2 minutes, and remained dependent on mechanical ventilation after return of circulation.

There were no between-group differences in the primary outcome, and the rates of survival at 12 months between the hypothermia and normothermia groups were also similar (49% and 46%, respectively). The trial was stopped after a review of interim efficacy results due to an assessment of futility.

COMMENT

Despite these authors' valiant attempt to control the therapeutic interventions, some variables might have affected the outcomes. For example, it took approximately 5 hours to initiate the interventions after the return of circulation. Would outcomes have been different if the interventions had been carried out more quickly? Are these target temperatures the correct ones? 

Therapeutic Hypothermia after In-Hospital Cardiac Arrest in Children