Masakazu Matsuzaki1, Naoya Matsumoto1, Ken Nagao1, Hirotaka Sawano2, Hiroyuki Yokoyama3, Yoshio Tahara3, Mamoru Hase4, Shinichi Shirai5, Hiroshi Hazui6, Hideki Arimoto7, Kazunori Kashiwase8, Shunji Kasaoka9, Tomokazu Motomura10, Yasuhiro Kuroda11, Yuji Yasuga12, Naohiro Yonemoto13, Hiroshi Nonogi14. 1. Department of Cardiology, Nihon University Hospital. 2. Senri Critical Care Medical Center, Saiseikai Senri Hospital. 3. National Cerebral and Cardiovascular Center. 4. Emergency and Critical Care Center, Sapporo City University Hospital. 5. Division of Cardiology, Kokura Memorial Hospital. 6. Emergency Medicine, Osaka Mishima Emergency and Critical Care Center. 7. Emergency and Critical Care Medical Center, Osaka City General Hospital. 8. Division of Cardiology, Osaka Police Hospital. 9. Disaster Medical Education and Research Center, Kumamoto University Hospital. 10. Department of Emergency Medicine, Saga University Hospital. 11. Emergency and Critical Care Center, Kagawa University Hospital. 12. Department of Cardiology, Sumitomo Hospital. 13. Department of Public Health, Juntendo University. 14. Faculty of Health Science, Osaka Aoyama University.
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.
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: Mehdi Javanbakht; Atefeh Mashayekhi; Mohsen Rezaei Hemami; Michael Branagan-Harris; Thomas R Keeble; Mohsen Yaghoubi Journal: Pharmacoecon Open Date: 2022-05-03