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ESC Congress 2003: Hypothermia - good for both brain and heart?

September 02, 2003

IMPORTANT: This press release accompanies both a presentation and an ESC press conference given at the ESC Congress 2003. Written by the investigator himself/herself, this press release does not necessarily reflect the opinion of the European Society of Cardiology

ESC Congress 2003: Cold comfort - cough for your life

Sudden death from cardiac arrest is a major health problem that still receives too little publicity. Current therapy after cardiac arrest concentrates on resuscitation efforts as until now no specific therapy for brain protection after restoration of spontaneous circulation was available. Therapeutic mild or moderate resuscitative hypothermia is a novel therapy with multifaceted chemical and physical effects by preventing or mitigating the derangements seen in the postresuscitation syndrome.
A systematic review of the literature and individual patient data meta-analysis was performed to assess whether induced hypothermia improves neurologic recovery in primary cardiac arrest survivors. Three randomized trials of therapeutic hypothermia have been identified: one trial involved 9 centers (275 patients; cooling method: cooled air; target temperature 33°C for 24 hours), one involved 4 centers (77 patients; ice packs; 33°C for 12 hours), and one involved one center (33 patients; cooling helmet; 34°C for 4 hours). All three studies followed patients at least until death or hospital discharge. More patients in the hypothermia group were discharged with favorable neurologic recovery (risk ratio 1.68, 95% confidence interval 1.29 to 2.07). The 95% confidence interval of the number-needed-to-be-treated to allow one additional patient to leave the hospital neurologically intact was 4 to 13. One study followed patients up to 6 months or death. Being alive at 6 months with favorable functional neurological recovery was more likely in the hypothermia group (risk ratio 1.44, 1.11 to 1.76).
Mild therapeutic hypothermia improves short-term neurologic recovery and survival in patients resuscitated from cardiac arrest of presumed cardiac origin.
However several issues with regard to resuscitative cooling are still unanswered and should be further studied. These include the best timing when to initiate cooling, the optimal period of cooling, the optimal temperature level and re-warming strategy. Even such important questions as which cooling technique will be available in the near future, that should combine ease of use with high efficacy are not answered yet.
Even so an advisory statement by the Advanced Life Support Task Force of the International Liaison Committee on Resuscitation on therapeutic hypothermia after cardiac arrest (Jerry P. Nolan, Peter T. Morley, Terry L. Vanden Hoek, Robert W. Hickey) stated in Resuscitation 2003; 57:231 and Circulation 2003; 108:118 that unconscious adult patients with spontaneous circulation after out-of-hospital cardiac arrest should be cooled to 32-34°C for 12-24 h when the initial rhythm was ventricular fibrillation. Such cooling may also be beneficial for other rhythms or in-hospital cardiac arrest.

Fritz Sterz
Allgemeines Krankenhaus der Stadt Wien, Universit'¤tsklinik für Notfallmedizin, Vienna
Austria

European Society of Cardiology (ESC)