TY - JOUR

T1 - Duration of Device-Based Fever Prevention after Cardiac Arrest.

AU - Hassager, Christian

AU - Schmidt, Henrik

AU - Møller, Jacob E.

AU - Grand, Johannes

AU - Mølstrøm, Simon

AU - Beske, Rasmus P.

AU - Boesgaard, Søren

AU - Borregaard, Britt

AU - Bekker-Jensen, Ditte

AU - Dahl, Jordi S.

AU - Frydland, Martin S.

AU - Høfsten, Dan E.

AU - Isse, Yusuf A.

AU - Josiassen, Jakob

AU - Lind Jørgensen, Vibeke R.

AU - Kondziella, Daniel

AU - Lindholm, Matias G.

AU - Moser, Emil

AU - Nyholm, Benjamin C.

AU - Obling, Laust E. R.

AU - Sarkisian, Laura

AU - Søndergaard, Frederik T.

AU - Thomsen, Jakob H.

AU - Thune, Jens J.

AU - Venø, Søren

AU - Wiberg, Sebastian C.

AU - Winther-Jensen, Matilde

AU - Meyer, Martin A. S.

AU - Kjaergaard, Jesper

N1 - Publisher Copyright: © 2022 Massachusetts Medical Society.

PY - 2023

Y1 - 2023

N2 - Background Guidelines recommend active fever prevention for 72 hours after cardiac arrest. Data from randomized clinical trials of this intervention have been lacking. Methods We randomly assigned comatose patients who had been resuscitated after an out-of-hospital cardiac arrest of presumed cardiac cause to device-based temperature control targeting 36°C for 24 hours followed by targeting of 37°C for either 12 or 48 hours (for total intervention times of 36 and 72 hours, respectively) or until the patient regained consciousness. The primary outcome was a composite of death from any cause or hospital discharge with a Cerebral Performance Category of 3 or 4 (range, 1 to 5, with higher scores indicating more severe disability; a category of 3 or 4 indicates severe cerebral disability or coma) within 90 days after randomization. Secondary outcomes included death from any cause and the Montreal Cognitive Assessment score (range, 0 to 30, with higher scores indicating better cognitive ability) at 3 months. Results A total of 393 patients were randomly assigned to temperature control for 36 hours, and 396 patients were assigned to temperature control for 72 hours. At 90 days after randomization, a primary end-point event had occurred in 127 of 393 patients (32.3%) in the 36-hour group and in 133 of 396 patients (33.6%) in the 72-hour group (hazard ratio, 0.99; 95% confidence interval, 0.77 to 1.26; P=0.70) and mortality was 29.5% in the 36-hour group and 30.3% in the 72-hour group. At 3 months, the median Montreal Cognitive Assessment score was 26 (interquartile range, 24 to 29) and 27 (interquartile range, 24 to 28), respectively. There was no significant between-group difference in the incidence of adverse events. Conclusions Active device-based fever prevention for 36 or 72 hours after cardiac arrest did not result in significantly different percentages of patients dying or having severe disability or coma. (Funded by the Novo Nordisk Foundation; BOX ClinicalTrials.gov number, NCT03141099.)

AB - Background Guidelines recommend active fever prevention for 72 hours after cardiac arrest. Data from randomized clinical trials of this intervention have been lacking. Methods We randomly assigned comatose patients who had been resuscitated after an out-of-hospital cardiac arrest of presumed cardiac cause to device-based temperature control targeting 36°C for 24 hours followed by targeting of 37°C for either 12 or 48 hours (for total intervention times of 36 and 72 hours, respectively) or until the patient regained consciousness. The primary outcome was a composite of death from any cause or hospital discharge with a Cerebral Performance Category of 3 or 4 (range, 1 to 5, with higher scores indicating more severe disability; a category of 3 or 4 indicates severe cerebral disability or coma) within 90 days after randomization. Secondary outcomes included death from any cause and the Montreal Cognitive Assessment score (range, 0 to 30, with higher scores indicating better cognitive ability) at 3 months. Results A total of 393 patients were randomly assigned to temperature control for 36 hours, and 396 patients were assigned to temperature control for 72 hours. At 90 days after randomization, a primary end-point event had occurred in 127 of 393 patients (32.3%) in the 36-hour group and in 133 of 396 patients (33.6%) in the 72-hour group (hazard ratio, 0.99; 95% confidence interval, 0.77 to 1.26; P=0.70) and mortality was 29.5% in the 36-hour group and 30.3% in the 72-hour group. At 3 months, the median Montreal Cognitive Assessment score was 26 (interquartile range, 24 to 29) and 27 (interquartile range, 24 to 28), respectively. There was no significant between-group difference in the incidence of adverse events. Conclusions Active device-based fever prevention for 36 or 72 hours after cardiac arrest did not result in significantly different percentages of patients dying or having severe disability or coma. (Funded by the Novo Nordisk Foundation; BOX ClinicalTrials.gov number, NCT03141099.)

KW - Cardiac Arrest

KW - Cardiology

KW - Cardiology General

KW - Clinical Medicine

KW - Clinical Medicine General

KW - Coma/Brain Death

KW - Critical Care

KW - Emergency Medicine

KW - Emergency Medicine General

KW - Hospital-Based Clinical Medicine

KW - Neurology/Neurosurgery

KW - Neurology/Neurosurgery General

KW - Pulmonary/Critical Care

KW - Pulmonary/Critical Care General

U2 - 10.1056/NEJMoa2212528

DO - 10.1056/NEJMoa2212528

M3 - Journal article

C2 - 36342119

AN - SCOPUS:85150000006

VL - 388

SP - 888

EP - 897

JO - New England Journal of Medicine

JF - New England Journal of Medicine

SN - 0028-4793

IS - 10

ER -