Randomized controlled trial of internal and external targeted temperature management methods in post- cardiac arrest patients

Am J Emerg Med. 2018 Jan;36(1):66-72. doi: 10.1016/j.ajem.2017.07.017. Epub 2017 Jul 5.

Abstract

Background: Targeted temperature management post-cardiac arrest is currently implemented using various methods, broadly categorized as internal and external. This study aimed to evaluate survival-to-hospital discharge and neurological outcomes (Glasgow-Pittsburgh Score) of post-cardiac arrest patients undergoing internal cooling verses external cooling.

Methodology: A randomized controlled trial of post-resuscitation cardiac arrest patients was conducted from October 2008-September 2014. Patients were randomized to either internal or external cooling methods. Historical controls were selected matched by age and gender. Analysis using SPSS version 21.0 presented descriptive statistics and frequencies while univariate logistic regression was done using R 3.1.3.

Results: 23 patients were randomized to internal cooling and 22 patients to external cooling and 42 matched controls were selected. No significant difference was seen between internal and external cooling in terms of survival, neurological outcomes and complications. However in the internal cooling arm, there was lower risk of developing overcooling (p=0.01) and rebound hyperthermia (p=0.02). Compared to normothermia, internal cooling had higher survival (OR=3.36, 95% CI=(1.130, 10.412), and lower risk of developing cardiac arrhythmias (OR=0.18, 95% CI=(0.04, 0.63)). Subgroup analysis showed those with cardiac cause of arrest (OR=4.29, 95% CI=(1.26, 15.80)) and sustained ROSC (OR=5.50, 95% CI=(1.64, 20.39)) had better survival with internal cooling compared to normothermia. Cooling curves showed tighter temperature control for internal compared to external cooling.

Conclusion: Internal cooling showed tighter temperature control compared to external cooling. Internal cooling can potentially provide better survival-to-hospital discharge outcomes and reduce cardiac arrhythmia complications in carefully selected patients as compared to normothermia.

Keywords: Cardiac arrest; Emergency department; Neurological function; Survival outcomes; Targeted temperature management.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Arrhythmias, Cardiac / etiology
  • Cardiopulmonary Resuscitation*
  • Female
  • Humans
  • Hypothermia, Induced / methods*
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Out-of-Hospital Cardiac Arrest / mortality*
  • Out-of-Hospital Cardiac Arrest / therapy*
  • Patient Discharge
  • Prospective Studies
  • Singapore
  • Survival Rate