Endovascular cooling improves neurological short-term outcome after prehospital cardiac arrest

Abstract

Mild hypothermia following successful resuscitation from prehospital cardiac arrest has shown to improve patient's short-term neurological outcome. Usually, extracorporal methods are performed to achieve a core temperature of 32–34 °C. Recently, an endovascular cooling device has proven to be safe and feasible to induce mild hypothermia. Because of precise target temperature control in daily clinical routine, the endovascular method might lead to more favorable neurological outcomes than extracorporal cooling using cold packs. We retrospectively studied 39 patients after prehospital cardiac arrest from various causes, who were treated with mild hypothermia for 24 h either by an endovascular cooling device (group 1; n=19) or by an extracorporal method (group 2; n=20) using cold packs. Target temperature was 33 °C in group 1 and 32-34 °C in group 2. The efficiacy of the cooling procedure and patient's neurological outcome (classified by cerebral performance category CPC) at the time of hospital discharge were compared between both groups. Patient's baseline characteristics were comparable between both groups. During hypothermia, the target temperature was reached in all cases in group 1 but only in two cases in group 2 (p<0.001). Mean core temperature was 32.9±0.1 °C in group 1 and 36.1±1.3 °C in group 2 (p<0.001). At the time of hospital discharge, more patients in group 1 had a good neurological outcome (group 1 vs group 2, 47.4% CPC 1/2 vs 20.0% CPC 1/2; p=0.08). In the subgroup of nondiabetic patients, this difference was even more pronounced (group 1 vs group 2, 63.6% CPC 1/2 vs 23.1% CPC 1/2; p=0.007). Compared to an extracorporal method using cold packs, endovascular cooling can improve neurological short-term outcome after prehospital cardiac arrest, especially in non-diabetics. This effect results from better target temperature control in daily clinical routine.