Therapeutic induced hypothermia does not improve the prognosis of out-of-hospital cardiac arrest patients.

Abstract

Unconscious patients admitted to critical care units after out-of-hospital cardiac arrest are at high risk for death, and neurologic deficits are common among those who survive. The target temperature management (TTM), 33 vs. 36 °C, after out-of-hospital cardiac arrest trial was conducted to assess the benefits and harms of two targeted temperature regimens after out-of-hospital cardiac arrest of presumed cardiac cause. The study randomized 950 unconscious survivors of out-of-hospital cardiac arrest with presumed cardiac cause to a target temperature of 33 vs. 36 °C following return of spontaneous circulation (ROSC), irrespective of the initial rhythm. At the end of the trial, 50% of the patients in the 33 °C group (235 of 473 patients) had died, as compared to 48% of the patients in the 36 °C group (225 of 466 patients) [hazard ratio with a temperature of 33 °C 1.06; 95% confidence interval (CI) 0.89-1.28; p = 0.51]. In unconscious survivors of out-of-hospital cardiac arrest of presumed cardiac cause, hypothermia at a targeted temperature of 33 °C does not confer a survival benefit as compared to a targeted temperature of 36 °C.