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Prehospital induction of moderate hypothermia after cardiac resuscitation can increase survival without increasing neurologic impairment: a case-control study

Corral Torres E, Fernández Avilés F, López De Sa E, Martín Benítez JC, Montejo JC, Martín Reyes R, Saavedra Cervantes R

SAMUR Protecci√≥n Civil. Madrid, Spain. Hospital Gregorio Mara√Ī√≥n. Madrid, Spain. Hospital La Paz. Madrid, Spain. 4Hospital 12 de Octubre. Madrid, Spain. Hospital Cl√≠nico San Carlos. Madrid, Spain. Fundaci√≥n Jim√©nez D√≠az. Madrid, Spain.

Objectives: To assess the effect of early prehospital emergency responder implementation
of moderate hypothermia on neurologic outcome in patients recovering from cardiac
Methods: Case-control comparative study. The cases were the first 40 patients in
cardiorespiratory arrest in whom hypothermia was induced in the ambulance after
resuscitation by responders from the Citizen Protection Emergency Service of Madrid
(SAMUR); hypothermia was also later used in the hospital. The controls were the last 40
patients in cardiorespiratory arrest who were resuscitated by the SAMUR responders
before the prehospital hypothermia protocol had been established; hypothermia was
later induced after the control patients’ arrival at the hospital. Patients whose
cardiorespiratory arrest had neurologic causes were excluded given that the effect on
neurologic outcome was under evaluation. The Cerebral Performance Category scale
was used to assess impairment. A grade 1 or 2 assessment was considered to indicate a
good neurologic outcome.
Results: Neurologic outcome was good for 50% of the patients in whom hypothermia was
induced early; outcome was good for 27.5% of the control patients (P=.039). The
significant difference between cases and controls was maintained regardless of whether the
initial heart rhythm was shockable (58.3% of such cases had good neurologic outcomes
with early hypothermia vs 37.5% of the controls with shockable rhythm) or not (42.8% of
such cases had good outcomes vs 14.2% of the controls with nonshockable rhythm).
Conclusions: Our findings show a significant relationship between prehospital induction
of moderate hypothermia and a higher probability of neurologic recovery (performance
categories 1 and 2). If moderate hypothermia is initiated before arrival at the hospital, the
likelihood of good neurologic recovery is 2.6-times greater.

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