22
Targeted normothermia, 37 degrees
Moderate therapeutic hypothermia, 33 degrees for the first 24 hours
Open-label for treating clinicians; the primary endpoint interval barely excludes zero; mortality unchanged; conducted in 25 French ICUs and may not transfer.
Comatose adults admitted to intensive care after resuscitation from cardiac arrest with a NON-SHOCKABLE initial rhythm (asystole or pulseless electrical activity)
Survival with a favourable neurological outcome (Cerebral Performance Category 1 or 2) at day 90, blinded assessment
29 of 284 (10.2%) in the hypothermia group versus 17 of 297 (5.7%) in the normothermia group. Absolute difference 4.5 percentage points (0.1 to 8.9), P = 0.04. Mortality at 90 days did not differ (81.3% versus 83.2%). Prespecified adverse events did not differ.
Nothing about ECPR. These patients had a return of spontaneous circulation and no extracorporeal circuit, so their temperature was not being set by a heat exchanger. The favourable-outcome difference is 4.5 points with a lower bound of 0.1, and mortality was unchanged — so the result is fragile and is about disability among survivors rather than about survival.
The one modern temperature trial that was positive, and it studied the deepest cerebral insult in the randomised literature. It is the empirical anchor for the insult-severity argument used in Chapter 22 Controversy 3: temperature management may work where the injury is large enough for it to act on, and the neutral modern trials were conducted in populations with bystander CPR rates near 80% and arrests of about a minute before compressions began.