Pilot prospective study of therapeutic hypothermia for treatment of post-cardiac arrest patients

摘要

Survival to hospital discharge after out-of-hospital cardiac arrest (OHCA) in Singapore is a mere 2.7% [1]. Therapeutic hypothermia (TH) is a method of preserving vital organ and neurological function following global anoxia in cardiac arrest [2], by controlled lowering of core body temperature to improve the oxygen supply-and-demand mismatch and attenuate ischemic-reperfusion injury. The revised 2010 guidelines by AHA stated that initiating TH is now considered as standard post-resuscitation care for comatose cardiac arrest patients [3]. This study aimed to determine if TH can reduce mortality and improve neurological outcomes in post-resuscitated cardiac arrest patients.The study was a before-after phased case-control study comparing survival-to-hospital discharge or 30-days post-arrest and neurological status in cardiac arrest patients before implementation of TH (March 2006-July 2008) and after (October 2008-May 2013). This study was nested within an ongoing prospective randomized controlled trial comparing internal and external methods for TH. All in-hospital cardiac arrest (1HCA) or OHCA patients aged 18-80 years with sustained ROSC for >30 min, comatose with GCS <8 and with systolic BP >90mmHg with or without inotropic support were included. Primary outcome was survival-to-discharge or 30-days post-arrest. Retrospective nor-mothermic controls from our cardiac arrest registry were matched based on age and gender on a 1:1 ratio. Since the subjects enrolled were unconscious and unable to provide consent for enrollment, delayed consent was sought by relatives and this was approved by ethics committee of Singapore General Hospital. The authors of this manuscript have certified that they comply with the Principles of Ethical Publishing in the International Journal of Cardiology.