מתוך medicontext.co.il
NEW YORK (Reuters Health) – Mild hypothermia seems to improve the neurologic outcomes and survival of patients who have been resuscitated after cardiac arrest, according to findings from two studies published in the February 21st issue of The New England Journal of Medicine.
In one study, Dr. Fritz Stetz, from the Universitatsklinik fur Notfallmedizin in Vienna, Austria, and colleagues assessed the outcomes of 275 patients resuscitated after cardiac arrest who were randomized to receive therapeutic hypothermia or standard normothermic treatment over a 24-hour period. In all patients the cardiac arrest was due to ventricular fibrillation. The target temperature for the hypothermia intervention was 32 to 34 degrees Celsius.
Fifty-five percent of patients in the hypothermia group had a favorable neurologic outcome compared with 39% of patients in the normothermia group (p = 0.009), the authors report. Furthermore, the 6-month mortality rates in the hypothermia and normothermia groups were 41% and 55%, respectively. The complication rates were similar in each group.
Dr. Stephen A. Bernard, from Dandenong Hospital in Australia, and colleagues performed a similar study involving 77 comatose survivors of out-of-hospital cardiac arrest. The hypothermic goal in this study was to achieve a temperature of 33 degrees Celsius no longer than 2 hours after the return of spontaneous circulation and then to maintain this temperature for 12 hours.
Forty-nine percent of the patients treated with hypothermia survived and had a good neurologic outcome compared with 26% of normothermia-treated patients. Multivariate analysis confirmed that hypothermia-treated patients were much more likely to experience good outcomes (p = 0.011).
As in the first study, hypothermia was not linked to an increased complication rate.
In a related editorial, Drs. Peter J. Safar and Patrick M. Kochanek, from the University of Pittsburgh Medical Center, comment that "the findings in these trials are important, because in the US so far, permanent brain damage after cardiopulmonary-cerebral resuscitation causes many delayed deaths and is seen in about 10% to 30% of survivors of out-of-hospital cardiac arrest."
It is possible that hypothermia may have harmful effects on regenerative or reparative mechanisms and further studies are needed to evaluate this. Despite this possibility, Dr. Safar and Dr. Kochanek "recommend the use of mild hypothermia in survivors of cardiac arrest–as early as possible and for at least 12 hours."
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