Endovascular versus External Targeted Temperature Management for Out-of-Hospital Cardiac Arrest XXXX : A Randomized Controlled Study.

@entity1 @entity548 @entity12464 @entity16 @entity1003 @entity1167 @entity2332
BACKGROUND: -Targeted temperature management is recommended after out-of-hospital @entity1167 (OHCA). Whether advanced internal cooling is superior to basic external cooling remains presently unknown. The aim of this multicenter controlled trial was to evaluate the benefit of endovascular versus basic surface cooling. METHODS AND RESULTS: -Inclusion criteria were: age 18-79, OHCA related to a presumed cardiac cause, time to @entity12464 ( @entity12464 ) <60min, delay between @entity12464 and inclusion <240min, unconscious @entity1 after @entity12464 and prior to start cooling. Exclusion criteria were: terminal disease, pregnancy, known @entity1003 , uncontrolled @entity548 , temperature on admission <30  C, in-hospital CA, immediate need for extracorporeal life support or hemodialysis. @entity1 were randomized between two cooling strategies: endovascular femoral devices (Icy catheter, Coolgard(TM), Zoll, formerly Alsius, USA, n=203) or basic external cooling using fans, a home-made tent, and ice packs (n=197). The primary endpoint, i.e. favorable outcome evaluated by survival without major @entity16 (Cerebral Performance Categories 1-2) at day 28, was not significantly different between groups (odds ratio 1.41 [0.93-2.16], P=0.107). Improvement of favorable outcome at day 90 in favor of endovascular group did not reach significance (odds ratio 1.51 [0.96-2.35], P=0.07). Time to target temperature (33  C) was significantly shorter, and @entity2332 was more strictly maintained in the endovascular versus the surface group (P<0.001). Minor side effects directly related to the cooling method were more frequently observed in the endovascular group (P=0.009). CONCLUSIONS: -Despite @entity2332 induction and maintenance, endovascular cooling was not significantly superior to basic external cooling regarding favorable outcome. Clinical Trial Registration Information-ClinicalTrials.gov. Identifier: NCT00392639.
