In a multicenter, randomized control trial of 295 pediatric patients who suffered out of hospital cardiac arrest, targeted temperature management with hypothermia (33 C) vs. normothermia (36.8 C) did not significantly improve survival with good neurobehavioral outcome (as measured by Vineland Adaptive Behavior Scale II).
In a multicenter, randomized, control trial, comparing temperature management at 33°C with 36°C in 939 comatose patients after out-of-hospital cardiac arrest of presumed cardiac cause, there was no difference in mortality at the end of the trial (33°C group 50% vs 36°C group 48%; hazard ratio with 33°C, 1.06; 95% CI 0.89 to 1.28; P = 0.51), 180-day composite of mortality and poor neurological function (54% vs. 52%, respectively; RR 1.02; 95% CI 0.88 to 1.16; P = 0.78), or serious adverse events (93% vs. 90%, respectively; RR 1.03; 95% CI 1.00 to 1.08; P = 0.09).
In a multicentre, blinded, randomised, controlled trial comparing therapeutic hypothermia (33°C, achieved within 2 hours of ROSC and maintained for 12 hours) with normothermia in 77 comatose survivors of out-of-hospital VF cardiac arrest, hypothermia improved survival with a good outcome (49% versus 26%, p=0.046; odds ratio 5.25, 95% CI 1.47 to 18.76, p = 0.011). Hypothermia was associated with a lower cardiac index, higher systemic vascular resistance, hyperglycemia, with no difference in the frequency of adverse events.
In a multicentre, blinded, randomized, controlled trial comparing therapeutic hypothermia (32°C to 34°C for 24 hours) with normothermia in 273 comatose survivors of out-of-hospital VF/VT, hypothermia improved favourable neurological outcomes (55% vs 39%; RR 1.40, 95% CI 1.08 to 1.81) and 6 month mortality (41% vs 55%; RR 0.74, 95% CI 0.58 to 0.95). The complication rate did not differ significantly between the two groups.
Among patients with cardiac arrest requiring vasopressors, combined vasopressin-epinephrine and methylprednisolone during CPR and stress-dose hydrocortisone in postresuscitation shock, compared with epinephrine/saline placebo, resulted in improved survival to hospital discharge with favorable neurological status.
Among adults with out-of-hospital cardiac arrest, there was no significant difference in 4-hour survival between patients treated with the mechanical CPR algorithm or those treated with guideline-adherent manual CPR.
Both survival and neurologic outcomes after in-hospital cardiac arrest have improved during the past decade at hospitals participating in a large national quality-improvement registry. Risk-adjusted rates of survival to discharge increased from 13.7% in 2000 to 22.3% in 2009 (adjusted rate ratio per year, 1.04; 95% confidence interval [CI], 1.03 to 1.06; P<0.001 for trend).