CAPITAL CHILL
Trial question
Is moderate therapeutic hypothermia superior to mild therapeutic hypothermia among comatose survivors of out-of-hospital cardiac arrest?
Study design
Single center
Double blinded
RCT
Population
Characteristics of study participants
19.0% female
81.0% male
N = 367
367 patients (69 female, 298 male).
Inclusion criteria: patients with out-of-hospital cardiac arrest surviving to hospital admission and referred for post-cardiac arrest care.
Key exclusion criteria: known inability to perform activities of daily living, cardiac arrest secondary to intracranial bleed, severe coagulopathy with clinical evidence of major bleeding, coma not attributable to the cardiac arrest.
Interventions
N=193 moderate hypothermia (a target body temperature of 31 degree Celsius for a period of 24 hours).
N=196 mild hypothermia (a target body temperature of 34 degree Celsius for a period of 24 hours).
Primary outcome
Death or poor neurologic outcome at day 180
48.4%
45.4%
48.4 %
36.3 %
24.2 %
12.1 %
0.0 %
Moderate
hypothermia
Mild
hypothermia
No significant
difference ↔
No significant difference in death or poor neurologic outcome at day 180 (48.4% vs. 45.4%; RR 1.07, 95% CI 0.86 to 1.33).
Secondary outcomes
No significant difference in death at day 180 (43.5% vs. 41%; RR 1.06, 95% CI 0.83 to 1.35).
No significant difference in stroke at day 180 (4.4% vs. 1.6%; RR 2.65, 95% CI 0.71 to 9.84).
No significant difference in length of stay in the ICU (10 days vs. 7 days; AD 1.4 days, 95% CI -1.2 to 4.1).
Safety outcomes
No significant differences in DVT, IVC thrombus.
Conclusion
In patients with out-of-hospital cardiac arrest surviving to hospital admission and referred for post-cardiac arrest care, moderate hypothermia was not superior to mild hypothermia with respect to death or poor neurologic outcome at day 180.
Reference
Michel Le May, Christina Osborne, Juan Russo et al. Effect of Moderate vs Mild Therapeutic Hypothermia on Mortality and Neurologic Outcomes in Comatose Survivors of Out-of-Hospital Cardiac Arrest: The CAPITAL CHILL Randomized Clinical Trial. JAMA. 2021 Oct 19;326(15):1494-1503.
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