Effect of prehospital induction of mild hypothermia on 3-month neurological status and 1-year survival among adults with cardiac arrest: long-term follow-up of a randomized, clinical trial

J Am Heart Assoc. 2015 Mar 11;4(3):e001693. doi: 10.1161/JAHA.114.001693.

Abstract

Background: Randomized trials of prehospital cooling after cardiac arrest have shown that neither prehospital cooling nor targeted temperature management differentially affected short-term survival or neurological function. In this follow-up study, we assess the association of prehospital hypothermia with neurological function at least 3 months after cardiac arrest and survival 1 year after cardiac arrest.

Methods and results: There were 508 individuals who were discharged alive from hospitals in King County, Washington; 373 (73%) were interviewed by telephone 123±43 days after the initial event. Overall, 59% of the treatment group and 58% of the control group had Cerebral Performance Category (CPC) 1 or 2 (P=0.70), and 50% of the treatment group and 49% of the control group had slight disability or better by the Modified Rankin Scale (MRS; (P=0.35). One-year survival was 87% in the treatment group and 84% in the control group (P=0.42). Of those with CPC 1 at hospital discharge, 68% had CPC 1 or 2 at follow-up, and 59% had MRS of slight disability or better. Of 41 patients with CPC 3 or 4 at discharge, only 12% had CPC 2 at follow-up, and just 5% had MRS of slight disability or better. One-year survival was 92% for CPC 1 at discharge, but only 40% for CPC 4.

Conclusion: In addition to excellent survival, patients who had good neurological function at discharge continued to have good function at least 3 months after the event.

Clinical trial registration: URL: Clinicaltrials.gov. Unique identifier: NCT00391469.

Keywords: arrhythmia; cardiac arrest; follow‐up study.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Disability Evaluation
  • Emergency Medical Services / methods*
  • Female
  • Follow-Up Studies
  • Humans
  • Hypothermia, Induced* / adverse effects
  • Hypothermia, Induced* / mortality
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Nervous System / physiopathology*
  • Neurologic Examination
  • Out-of-Hospital Cardiac Arrest / diagnosis
  • Out-of-Hospital Cardiac Arrest / mortality
  • Out-of-Hospital Cardiac Arrest / physiopathology
  • Out-of-Hospital Cardiac Arrest / therapy*
  • Patient Discharge
  • Predictive Value of Tests
  • Prospective Studies
  • Recovery of Function
  • Risk Factors
  • Time Factors
  • Treatment Outcome
  • Washington

Associated data

  • ClinicalTrials.gov/NCT00391469