Impact of Induced Therapeutic Hypothermia by Intravenous Infusion of Ice-Cold Fluids After Hospital Arrival in Comatose Survivors of Out-of-Hospital Cardiac Arrest With Initial Shockable Rhythm.

Abstract

BACKGROUND:

The effect of in-hospital rapid cooling by intravenous ice-cold fluids for comatose survivors of out-of-hospital cardiac arrest (OHCA) is unclear.Methods and Results:From the J-PULSE-HYPO study registry, data for 248 comatose survivors with return of spontaneous circulation (ROSC) who were treated with therapeutic hypothermia (34℃ for 12-72 h) after witnessed shockable OHCA were extracted. Patients were divided into 2 groups by the median collapse-to-ROSC interval (18 min), and then into 2 groups by cooling method (rapid cooling by intravenous ice-cold fluids vs. standard cooling). The primary endpoint was favorable neurological outcome (Cerebral Performance Category of 1 or 2) at 30 days after OHCA. In the whole cohort, the shorter collapse-to-ROSC interval group had significantly higher favorable neurological outcome than the longer collapse-to-ROSC interval group (78.2% vs. 46.8%, P<0.001). In the shorter collapse-to-ROSC interval group, no significant difference was observed in favorable neurological outcome between the 2 cooling groups (rapid cooling group: 79.4% vs. standard cooling group: 77.0%, P=0.75). In the longer collapse-to-ROSC interval group, however, favorable neurological outcome was significant higher in the rapid cooling group than in the standard cooling group (60.7% vs. 33.3%, P<0.01) and the adjusted odds ratio after rapid cooling was 3.069 (95% confidence interval 1.423-6.616, P=0.004).

CONCLUSIONS:

In-hospital rapid cooling by intravenous ice-cold fluids improved neurologically intact survival in comatose survivors whose collapse-to-ROSC interval was delayed over 18 min after shockable OHCA.

• Authors: Masakazu Matsuzaki, Naoya Matsumoto, Ken Nagao, Hirotaka Sawano, Hiroyuki Yokoyama, Yoshio Tahara, Mamoru Hase, Shinichi Shirai, Hiroshi Hazui, Hideki Arimoto, Kazunori Kashiwase, Shunji Kasaoka, Tomokazu Motomura, Yasuhiro Kuroda, Yuji Yasuga, Naohiro Yonemoto, Hiroshi Nonogi, J-PULSE-Hypo Investigators
• Journal: Circulation journal : official journal of the Japanese Circulation Society (Circ J) Vol. 85 Issue 10 Pg. 1842-1848 (09 24 2021) ISSN: 1347-4820 [Electronic] Japan
• PMID: 34261843 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Ice

Topics

• Cardiopulmonary Resuscitation (methods)
• Coma (etiology, therapy)
• Hospitals
• Humans
• Hypothermia, Induced (adverse effects, methods)
• Ice
• Infusions, Intravenous
• Out-of-Hospital Cardiac Arrest (therapy)
• Survivors