Hypothermia Does Not Cut Deaths in Patients With Coma After Cardiac Arrest
At six months, no reduction seen in death, severe disability or worse for those managed with hypothermia versus normothermia
THURSDAY, June 17, 2021 (HealthDay News) -- Targeted hypothermia does not lower the incidence of death at six months among patients with coma after out-of-hospital cardiac arrest, according to a study published in the June 17 issue of the New England Journal of Medicine.
Josef Dankiewicz, M.D., Ph.D., from Skåne University Hospital Lund in Sweden, and colleagues conducted an open-label trial with blinded assessment of outcomes involving adults with coma who had an out-of-hospital cardiac arrest and were randomly assigned to undergo targeted hypothermia at 33 degrees Celsius followed by controlled rewarming or targeted normothermia with early treatment of fever. A total of 1,850 patients were assessed for the primary outcome of death from any cause at six months.
The researchers found that 50 and 48 percent of patients in the hypothermia and normothermia group, respectively, had died at six months (relative risk with hypothermia, 1.04; 95 percent confidence interval, 0.94 to 1.14; P = 0.37). Of the 1,747 patients in whom the functional outcome was assessed, 55 and 55 percent of patients in the hypothermia and normothermia groups, respectively, had modified severe disability or worse (modified Rankin scale score ≥4) (relative risk with hypothermia, 1.00; 95 percent confidence interval, 0.92 to 1.09). In prespecified subgroups, outcomes were consistent.
"Patients with coma after out-of-hospital cardiac arrest who were treated with hypothermia did not have a lower incidence of death at six months than those who were treated with normothermia," the authors write.
Several authors disclosed financial ties to the biopharmaceutical and medical device industries; one author reports holding patents.