Neurology in critical care · Temperature after cardiac arrest
Hypothermia versus Normothermia after Out-of-Hospital Cardiac Arrest
| Design | International multicentre randomised trial |
|---|---|
| Treatment | Targeted hypothermia at 33°C |
| Control | Targeted normothermia with early treatment of fever |
| Population | 1850 patients comatose after out-of-hospital cardiac arrest |
| Follow-up | 6 months |
| Primary endpoint | Death from any cause at 6 months |
| Result | At 6 months 465 of 925 (50%) had died in the hypothermia group versus 446 of 925 (48%) in the normothermia group. Arrhythmia causing haemodynamic compromise was more common with hypothermia, 24% versus 17%. |
| Secondary endpoints | Functional outcome at 6 months, arrhythmia, adverse events |
In patients with coma after out-of-hospital cardiac arrest, targeted hypothermia did not lead to a lower incidence of death by 6 months than targeted normothermia.
The trial authors, in the published abstract
Reversed fifteen years of guideline-endorsed therapeutic hypothermia. What survived is fever prevention, which is what the control arm actually did — an important distinction, since 'no cooling' is not the same as 'normothermia actively maintained'.
Dankiewicz J, Cronberg T, Lilja G, et al. Hypothermia versus Normothermia after Out-of-Hospital Cardiac Arrest. N Engl J Med 2021 Jun 17;384(24):2283-2294.