Abstract 17210: Comparison of Therapeutic Hypothermia Between Core-cooling and Surface-cooling for Out-of-hospital Cardiac Arrest From a Multicenter Registry in Japan: J-PULSE-Hypo Registry
Background: The 2010 American Heart Association Guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC) recommend that comatose adult patients with return of spontaneous circulation (ROSC) after out-of-hospital ventricular fibrillation (VF) cardiac arrest should receive therapeutic hypothermia (TH: Class I). Recently several devices to induce TH are available, however, appropriate cooling method for TH is still controversial between core-cooling and surface-cooling.
Methods: We conducted a multicenter retrospective study at 14 institutions to evaluate the effect of therapeutic hypothermia on out-of-hospital cardiac arrest between January 2005 and March 2011. The study committee entrusted each hospital with timing of cooling, cooling methods, target temperature, duration, rewarming rate, and complications. Enrolled patients were divided into the Core-cooling group and the Surface-cooling group. Any complications, time to target temperature, precise temperature control, and neurological outcome were compared. A favorable outcome was defined as a Cerebral Performance Category (CPC) of 1-2.
Results: A total of 443 patients were enrolled in this study. There was no significant difference in the both groups. As compared with the Core-cooling group (n=218), the Surface-cooling group (n=225) had higher rates of temperature instability (48% vs. 9%, p<0.01), and temperature over shoot (32% vs. 10%, p<0.01). However the Core-cooling group had higher rates of blood transfusion (20% vs. 10%, p<0.01) and disseminated intravascular coagulation (12% vs. 0%, p<0.01). Both groups have favorable outcomes (53% vs. 61%, NS).
Conclusions: This study suggests that both device provide favorable outcomes, especially core-cooling has the advantage of precise temperature control. On the other hand, complication rates are higher than surface-cooling.
- © 2013 by American Heart Association, Inc.