• Ivan Laurent, Christophe Adrie, Christophe Vinsonneau, Alain Cariou, Jean-Daniel Chiche, Alice Ohanessian, Christian Spaulding, Pierre Carli, Jean-François Dhainaut, and Mehran Monchi.
• Medical ICU, Cochin Teaching Hospital, Rene Descartes University, Paris, France.
• J. Am. Coll. Cardiol. 2005 Aug 2;46(3):432-7.

ObjectivesThe study examined the effect of isovolumic high-volume hemofiltration (HF) alone or combined with mild hypothermia (HT) on survival after out-of-hospital cardiac arrest (OHCA) with initial ventricular fibrillation or asystole.BackgroundGlobal inflammation in response to whole-body ischemia-reperfusion is common after OHCA and may worsen the overall prognosis.MethodsSixty-one patients admitted between May 2000 and March 2002 in the intensive care units of two hospitals in France were randomized to one of three groups: control, HF (200 ml/kg/h over 8 h) or HF+HT (32 degrees C for 24 h) induced by cooling the HF substitution fluid. Standard supportive care was provided in all three groups. The primary end point was survival with a follow-up time of six months. The effect of HF on death by intractable shock was the secondary end point.ResultsThe six-month survival curves of the three groups were significantly different, with better survival in the HF group (p = 0.026) and in the HF+HT group (p = 0.018). After adjustment on baseline characteristics of cardiac arrest, HF (with or without HT) was associated with improved survival (logistic regression odds ratio, 4.4; 95% confidence interval [CI], 1.1 to 16.6). Compared to control group, the relative risk of death by intractable shock was 0.29 (95% CI, 0.09 to 0.91) in the HF+HT group and 0.21 (95% CI, 0.05 to 0.85) in the HF group.ConclusionsThe HF may improve the overall prognosis after resuscitation from OHCA. Combination of HF with mild HT is feasible and should be evaluated in larger trials.

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