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Invasive versus non-invasive cooling after in- and out-of-hospital cardiac arrest: a randomized trial

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Abstract

Introduction

Mild induced hypothermia (MIH) is indicated for comatose survivors of sudden cardiac arrest (SCA) to improve clinical outcome. In this study, we compared the efficacy of two different cooling devices for temperature management in SCA survivors.

Methods

Between April 2008 and August 2009, 80 patients after survived in-hospital (IHCA) and out-of-hospital cardiac arrest (OHCA) were included in this prospective, randomized, single center study. Hypothermia was induced after randomization by either invasive Coolgard® cooling or non-invasive ArcticSun® surface cooling at 33.0 °C core body temperature for 24 h followed by active rewarming. The primary endpoint was defined as the efficacy of both cooling systems, measured by neuron-specific enolase (NSE) levels as a surrogate parameter for brain damage. Secondary efficacy endpoints were the clinical and neurological outcome, time to start of cooling and reaching the target temperature, target temperature-maintenance and hypothermia-associated complications.

Results

NSE at 72 h did not differ significantly between the 2 groups with 16.5 ng/ml, interquartile range 11.8–46.5 in surface-cooled patients versus 19.0 ng/ml, interquartile range 11.0–42.0 in invasive-cooled patients, p = 0.99. Neurological and clinical outcome was similar in both groups. Target temperature of 33.0 °C was maintained more stable in the invasive group (33.0 versus 32.7 °C, p < 0.001). Bleeding complications were more frequent with invasive cooling (n = 17 [43.6 %] versus n = 7 [17.9 %]; p = 0.03).

Conclusion

Invasive cooling has advantages with respect to temperature management over surface cooling; however, did not result in different outcome as measured by NSE release in SCA survivors. Bleeding complications were more frequently encountered by invasive cooling.

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Acknowledgments

This study was supported in part by a research grant from the University of Leipzig-Heart Center. The final manuscript has been approved by all authors. The authors would like to thank Goetz Gelbrich, PhD, for his contribution to the design of this study. We also would like to thank the staff of the Intensive Care Unit of the University of Leipzig-Heart Center.

Conflict of interest

Undine Pittl, MD, and her co-authors have no conflict of interest. On behalf of all authors, the corresponding author states that there is no conflict of interest. None of the authors received any financial support for this study.

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Authors and Affiliations

  1. Department of Internal Medicine/Cardiology, University of Leipzig-Heart Center, Strümpellstr. 39, 04289, Leipzig, Germany

    Undine Pittl, Steffen Desch, Raluca Diosteanu, Denise Lehmann, Katharina Demmin, Gerhard Schuler & Holger Thiele

  2. Hospital Hietzing, Vienna, Austria

    Alexandra Schratter

  3. Hospital Freudenstadt, Freudenstadt, Germany

    Jacqueline Hörig

  4. MVZ Laboratory Dr. Reising-Ackermann and Colleagues, Leipzig, Germany

    Thorsten Klemm

  5. University of Leipzig, Coordination Centre for Clinical Trials, Leipzig, Germany

    Meinhard Mende

Authors
  1. Undine Pittl
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  2. Alexandra Schratter
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  3. Steffen Desch
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  4. Raluca Diosteanu
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  5. Denise Lehmann
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  6. Katharina Demmin
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  7. Jacqueline Hörig
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  8. Gerhard Schuler
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  9. Thorsten Klemm
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  10. Meinhard Mende
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  11. Holger Thiele
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Corresponding author

Correspondence to Undine Pittl.

Additional information

Trial registration: ClinicalTrials.gov NCT: 00843297.

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Pittl, U., Schratter, A., Desch, S. et al. Invasive versus non-invasive cooling after in- and out-of-hospital cardiac arrest: a randomized trial. Clin Res Cardiol 102, 607–614 (2013). https://doi.org/10.1007/s00392-013-0572-3

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  • DOI: https://doi.org/10.1007/s00392-013-0572-3

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