HYPERION

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Lascarrou J-B. "Targeted Temperature Management for Cardiac Arrest with Nonshockable Rhythm". N Engl J Med. 2019. :.
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Clinical Question

Bottom Line

Major Points

Guidelines

As of June 2018, no guidelines have been published that reflect the results of this trial.

Design

  • Multicenter, open-label, outcome assessor-blinded, randomized, controlled trial
  • N=581
    • Hypothermia (n=284)
    • Normothermia (n=297)
  • Setting: 25 academic and community ICU in France
  • Enrollment: January 2014 to January 2018
  • Follow-up: 90 days
  • Analysis:
  • Primary Outcome: survival with good neurological function (Cerebral Performance Category of 1 or 2) at 90 days

Population

Inclusion Criteria

  • ≥ 18 years old
  • in or out of hospital cardiac arrest from any cause
  • non-shockable rhythm (pulseless electrical activity or asystole)
  • Glasgow Coma Scale (GCS) ≤ 8 At ICU admission

Exclusion Criteria

  • no flow/perfusion time > 10 minutes (collapse to CRP)
  • low-flow/perfusion > 60 minutes (CPR to ROSC)
  • continuous epinephrine or norepinephrine infusion >1 mcg/kg/min
  • time from cardiac arrest to screening > 300 minutes
  • moribund condition
  • Child–Pugh-Turcotte class C
  • pregnancy or breast-feeding
  • status of being under guardianship
  • inmate at a correctional facility
  • previous inclusion in another

randomized, controlled trial involving patients with cardiac arrest in which the neurologic out- come at 90 days was assessed as the primary end point

  • lack of health insurance
  • refusal by next of kin for inclusion

Baseline Characteristics

Hypothermia Group displayed

  • Demographics: Median age 67 years, 66% male
  • Comobidities: median Charlson comorbidity index 4, 34% chronic pulmonary disease, 57% chronic heart disease
  • location of arrest: 48.6% residence, 25.7% public place, 25.7% in-patient
  • arrest details:
    • rhythm: 77.8% asystole, 11.6% plus less electrical activity, 10.6% unknown
    • bystander: 96.5% witnessed, 70.4% CPR initiated
  • Physiologic parameters:
  • Anthropomorphics: Weight
  • Labs:
  • Site of infection

Interventions

Outcomes

Comparisons are BLANK therapy vs. BLANK therapy.

Primary Outcomes

Secondary Outcomes

Subgroup Analysis

Adverse Events

Criticisms

  • 10% of population had an unknown rhythm which may have affected findings

Funding

  • French Ministry of Health
  • nonprofit health care institution Centre Hospitalier Départemental Vendée
  • Laerdal Foundation


Further Reading