The use of therapeutic hypothermia was linked to poorer survival rates and worse neurologic outcomes for in-hospital cardiac arrest patients.

In a propensity-score matched analysis, therapeutic hypothermia was associated with a relative 12% lower likelihood of in-hospital survival compared with usual care (27.4% versus 29.2%, P=0.01), Paul S. Chan, MD, Saint Luke’s Mid America Heart Institute in Kansas City, Mo., and colleagues found.

The likelihood of 1-year survival without severe neurological disability (Cerebral Performance Category score of 1 or 2) likewise favored usual care over the cooling intervention (20.5% versus 17.0%, P<0.001), the group reported in the Oct. 4 issue of the Journal of the American Medical Association.

The disadvantage to cooling was similar for patients with non-shockable (asystole and pulseless electrical activity) and shockable cardiac arrest rhythms (ventricular fibrillation and pulseless ventricular tachycardia) both for survival and neurologic outcomes (P=0.74 and P=0.88, respectively, for interaction).

“Current use of therapeutic hypothermia for in-hospital cardiac arrest may warrant reconsideration,” Chan’s group concluded.

“It’s not so surprising. We do suspect that hypothermia works, but it’s a different type of cardiac arrest,” commented Karl Kern, MD, co-director, University of Arizona Sarver Heart Center in Tucson.

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