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Summary of the HACA Trial
Therapeutic hypothermia improved 6-month neurologic outcome and mortality among patients with out-of-hospital VT/VF cardiac arrest. Note that hypothermia may be associated with certain complications, such as increased risk of bleeding and infection.
Key Points from HACA
- Included 275 patients with witnessed out-of-hospital cardiac arrest, VF/VT as an initial rhythm, EMS response time of 5-15 minutes, and no more than 60 minutes from collapse to ROSC
- Excluded patients responding to verbal commands post-arrest, known pre-existing coagulopathy
- Randomized patients to receive normothermia or hypothermia (32-34°C) with cool air blanket with or without ice packs x 24 hours, and then rewarmed over 8 hours
- All patients received midazolam, fentanyl, and pancuronium
- Primary endpoint (favorable neurologic outcome) occurred more often with hypothermia (55% vs. 39%, p=0.0009, NNT 6)
- Hypothermia demonstrated a reduction in 6-month mortality (55% vs. 41%, p=0.02, NNT 7)
- Hypothermia began a median of 105 min after ROSC, and goal temperature was achieved a median of 8 hrs after ROSC. 70% of patients required ice packs for cooling.
- Hypothermia was associated with a non-significant increase in complications within the first 7 days following arrest: minor/major bleeding (26% vs. 19%), pneumonia (37% vs. 29%), and sepsis (13% vs. 7%). Note that these complication rates are potentially inflated due to survival bias (dead patients cannot have complications)
Citation
Hypothermia after Cardiac Arrest Study Group. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med. 2002 Feb 21;346(8):549-56. PMID 11856793
