European Hypothermia Study

In the multicentered European study conducted by the HACA group (8), 3551 potentially eligible patients were screened with a waiver of consent, and 273 patients were included in the study. The study randomized patients to induced hypothermia for 24 hours versus standard normo-thermic post-ROSC care, with 137 patients in the hypothermia arm and 138 in the normothermia arm. The patients assigned to the hypothermia group were cooled to a target temperature of 32°C to 34°C via a covered external cooling mattress cover that delivers cold air over the entire body. The goal was to reach the target temperature within four hours from ROSC. Core temperature was monitored via a sensor in the urinary bladder catheter. The temperature was maintained at 32°C to 34°C for 24 hours from the start of cooling, followed by passive rewarming over a period of 8 hours. Patients were sedated with midazolam and provided with paralytics (vecuronium) to prevent shivering, a cause of rise in temperature. This is the only study that showed a significant difference in both mortality and functional outcome. Using the 5-point CPC, 55% of patients treated with hypothermia had a favorable outcome (CPC 1 and 2), compared to 39% in the normothermia control group (relative risk of good outcome: 1.40; 95% confidence interval (CI), CI: 1.08-1.81). The hypothermia arm also had significantly lower six-month mortality, at 41% compared to 55% of the control (risk ratio: 0.74; 95% CI: 0.58-0.95) (8).

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