PRINCESS and Neuroprotect Look at Strategies to Improve Out-of-Hospital Cardiac Arrest

Using a transnasal evaporative cooling method for out-of-hospital cardiac arrest may be hemodynamically safe and shorten the time to target temperature, according to results of the PRINCESS trial presented Nov. 11 at AHA 2018 in Chicago, IL.

Per Nordberg, MD, PhD, et al., looked at 677 out-of-hospital cardiac arrest patients who were randomized to a transnasal evaporative cooling technique vs. standard care.

Results showed that the primary outcome of survival with Cerebral Performance Category 1 at 90 days was 16.6 percent in the intervention group vs. 13.5 percent in the standard care group. The authors explain that "although there were potentially important clinical outcome differences, there was no statistically significant difference."

The researchers further explain that "cardiac arrest patients with ventricular fibrillation had the best effect of early cooling with a significantly improved complete neurologic recovery (33 percent vs. 20 percent). The earlier the cooling was initiated; the better neurologic outcome was seen."

Meanwhile, in the Neuroprotect trial, also presented Nov. 11 at AHA 2018, Koen Ameloot, MD, PhD, et al., looked at 112 survivors of out-of-hospital cardiac arrest who were unconscious at hospital admission and were randomly assigned to early goal directed hemodynamic optimization (EGDHO) – targeting a higher mean arterial blood pressure (85-100mmHg) in post-cardiac arrest patients during the first 36 hours after hospital admission – vs. standard care.

Results showed that EGDHO is safe and improved cerebral perfusion and oxygenation as compared to standard care. However, it did not reduce the extent of anoxic brain damage on DW-MRI or functional outcome, the primary outcome.

The authors conclude that "EGDHO clearly improved cerebral perfusion and oxygenation thereby for the first time providing the proof of concept for this therapy."

"These early studies of new techniques to treat this very high risk condition are disappointing. Cardiac arrest therapies remain extremely limited," commented Kim A. Eagle, MD, MACC, editor-in-chief of

Keywords: AHA18, AHA Annual Scientific Sessions, Coma, Out-of-Hospital Cardiac Arrest, Hemodynamics, Cardiopulmonary Resuscitation

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