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Title: A comparison of therapeutic hypothermia and strict therapeutic normothermia after cardiac arrest.
Austin Authors: Casamento, Andrew ;Minson, Adrian;Radford, Samuel T ;Mårtensson, Johan;Ridgeon, Elliott;Young, Paul;Bellomo, Rinaldo 
Affiliation: Intensive Care Unit, Austin Health, Heidelberg, Victoria, Australia
Intensive Care Unit, The Northern Hospital, Melbourne, Victoria, Australia
Section of Anaesthesia and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
Medical Research Institute of New Zealand, Wellington, New Zealand
Intensive Care Unit, Wellington Hospital, Wellington, New Zealand
School of Medicine, The University of Melbourne, Victoria, Australia
Issue Date: Sep-2016 2016-01-25
Publication information: Resuscitation 2016; 106: 83-8
Abstract: In a recent high-quality randomised controlled trial (RCT), strict therapeutic normothermia (STN) following cardiac arrest with coma resulted in similar outcomes to therapeutic hypothermia (TH). We aimed to test the feasibility, reproducibility, and safety of the STN protocol outside of its RCT context. In two teaching hospital ICUs, we performed a before-and-after study comparing the previously International Liaison Committee on Resuscitation (ILCOR)-endorsed TH protocol to the recently studied STN protocol. The primary feasibility end point was the percentage of temperature recordings in the prescribed range in the first 24h of treatment. Secondary end points included pharmacological management and complications. We studied 69 similar patients in each group. We found no difference in feasibility as shown by the proportion of within range temperatures. However, the median doses of midazolam (37mg vs. 9mg, p=0.02), fentanyl (883μg vs. 310μg, p=0.01) and the use of muscle relaxants (84.1% vs. 59.4%, p=0.001) was greater with the TH protocol. Furthermore, shivering (52.2% vs. 18.8%, p<0.001), a composite of other pre-defined complications (66.7% vs. 47.8%, p<0.03) and fever in the first 96h (55.1% vs. 33.3%, p=0.01) were also more common with the TH protocol. The STN protocol was successfully reproduced outside of an RCT and appeared associated with fewer complications than the TH protocol. Our findings imply that the STN protocol may offer clinical advantages over the TH protocol.
DOI: 10.1016/j.resuscitation.2016.06.019
ORCID: 0000-0001-7357-2024
PubMed URL: 27350372
Type: Journal Article
Subjects: Cardiac arrest
Strict therapeutic normothermia
Targeted temperature management
Therapeutic hypothermia
Appears in Collections:Journal articles

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