EBQ:HACA - Revision history

Danbot: Added Major Points

2026-03-21T22:56:40Z

Added Major Points

← Older revision		Revision as of 22:56, 21 March 2026
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	'''In patients who have been successfully resuscitated after cardiac arrest due to ventricular fibrillation, therapeutic mild hypothermia increased the rate of a favorable neurologic outcome and reduced mortality'''		'''In patients who have been successfully resuscitated after cardiac arrest due to ventricular fibrillation, therapeutic mild hypothermia increased the rate of a favorable neurologic outcome and reduced mortality'''

	==Major Points==		==Major Points==
			*HACA was one of two landmark trials (with Bernard 2002) that established therapeutic hypothermia for cardiac arrest
			*Cooling to 32-34C for 24 hours after VF cardiac arrest significantly improved neurological outcomes and survival
			*NNT of 6 for good neurological outcome at 6 months
			*Results led to widespread adoption of targeted temperature management in post-cardiac arrest protocols
			*The study included only witnessed VF arrest with ROSC within 60 minutes, limiting generalizability to other arrest rhythms

	{{Therapeutic hypothermia overview}}		{{Therapeutic hypothermia overview}}

Ostermayer: Text replacement - "Hypotension " to "Hypotension"

2017-03-10T12:59:12Z

Text replacement - "Hypotension " to "Hypotension"

← Older revision		Revision as of 12:59, 10 March 2017
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	*Pregnancy		*Pregnancy
	*Response to verbal commands after ROSC and before randomization		*Response to verbal commands after ROSC and before randomization
	*Hypotension (mean arterial pressure, less than 60 mm Hg) for more than 30 minutes after ROSC		*[[Hypotension]](mean arterial pressure, less than 60 mm Hg) for more than 30 minutes after ROSC
	*Hypoxemia (arterial oxygen saturation, less than 85 percent) for more than 15 minutes after ROSC		*Hypoxemia (arterial oxygen saturation, less than 85 percent) for more than 15 minutes after ROSC
	*Terminal illness that preceded the arrest		*Terminal illness that preceded the arrest

Ostermayer: Text replacement - "Hypothermia " to "Hypothermia"

2017-03-10T08:38:05Z

Text replacement - "Hypothermia " to "Hypothermia"

← Older revision		Revision as of 08:38, 10 March 2017
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	{{JC info		{{JC info
	\| title=Mild Therapeutic Hypothermia to Improve the Neurologic Outcome After Cardiac Arrest		\| title=Mild Therapeutic [[Hypothermia]]to Improve the Neurologic Outcome After Cardiac Arrest
	\| abbreviation=HACA		\| abbreviation=HACA
	\| expansion=Hypothermia After Cardiac Arrest		\| expansion=[[Hypothermia]]After Cardiac Arrest
	\| published=2002		\| published=2002
	\| author=Holzer M, et al		\| author=Holzer M, et al
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	*N=275		*N=275
	**Normothermia control group (n=138)		**Normothermia control group (n=138)
	**Hypothermia treatment group (n=137)		**[[Hypothermia]]treatment group (n=137)
	==Population==		==Population==
	*Emergency Department enrollment		*Emergency Department enrollment
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	==Interventions==		==Interventions==
	All patients received the same intensive care and were sedated with midazolam and fentanyl as well as maintained on mechanical ventilation. Pancuronium was used (0.1mg/kg Q2hrs) to reduce shivering.		All patients received the same intensive care and were sedated with midazolam and fentanyl as well as maintained on mechanical ventilation. Pancuronium was used (0.1mg/kg Q2hrs) to reduce shivering.
	===Hypothermia Group===		===[[Hypothermia]]Group===
	*The hypothermia group was cooled to 32°C to 34°C using the TheraKool device in order to reach the target bladder temperature within 4 hours and maintained fro 24hs since the start of the cooling.		*The hypothermia group was cooled to 32°C to 34°C using the TheraKool device in order to reach the target bladder temperature within 4 hours and maintained fro 24hs since the start of the cooling.
	*Passive rewarming occurred at 24hrs to a normothermic temperature >36° C over a median of 8hrs		*Passive rewarming occurred at 24hrs to a normothermic temperature >36° C over a median of 8hrs
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	'''Favorable neurologic outcome at 6 months:'''		'''Favorable neurologic outcome at 6 months:'''
	*Normothermia group: 39%		*Normothermia group: 39%
	*Hypothermia group: 55%		*[[Hypothermia]]group: 55%
	:p value = 0.009		:p value = 0.009
	:CI 1.08-1.81		:CI 1.08-1.81
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	'''6-month mortality'''		'''6-month mortality'''
	*55% Normothermia group		*55% Normothermia group
	*41% Hypothermia group		*41% [[Hypothermia]]group
	:p value = 0.02		:p value = 0.02
	:CI 0.58 - 0.95		:CI 0.58 - 0.95
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	==See Also==		==See Also==
	{{Hypothermia Cardiac Arrest Links}}		{{[[Hypothermia]]Cardiac Arrest Links}}

	==Sources==		==Sources==

Ostermayer: Text replacement - "Category:Neuro" to "Category:Neurology"

2016-03-22T14:15:16Z

Text replacement - "Category:Neuro" to "Category:Neurology"

← Older revision		Revision as of 14:15, 22 March 2016
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	[[Category:EBQ]]		[[Category:EBQ]]
	[[Category:Cardiology]]		[[Category:Cardiology]]
	[[Category:~~Neuro~~]]		[[Category:Neurology]]
	[[Category:Critical Care]]		[[Category:Critical Care]]
	[[Category:Featured]]		[[Category:Featured]]

Ostermayer: Text replacement - "Category:Cards" to "Category:Cardiology"

2016-03-22T13:53:48Z

Text replacement - "Category:Cards" to "Category:Cardiology"

← Older revision		Revision as of 13:53, 22 March 2016
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	[[Category:EBQ]]		[[Category:EBQ]]
	[[Category:~~Cards~~]]		[[Category:Cardiology]]
	[[Category:Neuro]]		[[Category:Neuro]]
	[[Category:Critical Care]]		[[Category:Critical Care]]
	[[Category:Featured]]		[[Category:Featured]]

DrJeffRogers at 21:41, 6 August 2015

2015-08-06T21:41:18Z

← Older revision		Revision as of 21:41, 6 August 2015
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	==Major Points==		==Major Points==
	*Therapeutic Hypothermia, define as deliberate cooling of a patient to 32-33.9°C (90-93F) who has no return of spontaneous neurologic activity after cardiac arrest. The goal is to reduce the repercussion injury to the brain which may be related to free radical formation, micro and macro circulation disruption and protease activation. At therapeutic temperatures the disruption of inflammatory and damaging cascades within the brain are thought to be decreased. <ref name="Cochrane">Arrich J, Holzer M, Herkner H, Müllner M. Hypothermia for neuroprotection in adults after cardiopulmonary resuscitation. Cochrane Database of Systematic Reviews 2009. PMID</ref>		{{Therapeutic hypothermia overview}}

	*The HACA Trial (Hypothermia after Cardiac Arrest) randomized patients after witness Ventricular Fibrillation (VF) and pulseless Ventricular Tachycardia (VT) to 32-34°C Hypothermia. There was a significant patient centered outcome and 6 month mortality decrease in the hypothermia group. A later trial by [[Bernard Hypothermia Trial\|Bernard et. al.]] demonstrated similar benefit and subsequent Cochrane reviews and the [[EBQ:TTM Trial\|TTM Trial]] (33°C vs 33°C) found similar mortality and morbidity benefits.<ref name="Cochrane"></ref>

	*Standard care established by the ACCF/AHA 2013 guidelines, recommend therapeutic hypothermia for any comatose patient with a STEMI and out of hospital cardiac arrest from VF or puleless VT<ref>http://www.ncbi.nlm.nih.gov/pubmed/23256913</ref>

	==Study Design==		==Study Design==

DrJeffRogers: /* Major Points */

2015-08-06T21:39:28Z

Major Points

← Older revision		Revision as of 21:39, 6 August 2015
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	*Therapeutic Hypothermia, define as deliberate cooling of a patient to 32-33.9°C (90-93F) who has no return of spontaneous neurologic activity after cardiac arrest. The goal is to reduce the repercussion injury to the brain which may be related to free radical formation, micro and macro circulation disruption and protease activation. At therapeutic temperatures the disruption of inflammatory and damaging cascades within the brain are thought to be decreased. <ref name="Cochrane">Arrich J, Holzer M, Herkner H, Müllner M. Hypothermia for neuroprotection in adults after cardiopulmonary resuscitation. Cochrane Database of Systematic Reviews 2009. PMID</ref>		*Therapeutic Hypothermia, define as deliberate cooling of a patient to 32-33.9°C (90-93F) who has no return of spontaneous neurologic activity after cardiac arrest. The goal is to reduce the repercussion injury to the brain which may be related to free radical formation, micro and macro circulation disruption and protease activation. At therapeutic temperatures the disruption of inflammatory and damaging cascades within the brain are thought to be decreased. <ref name="Cochrane">Arrich J, Holzer M, Herkner H, Müllner M. Hypothermia for neuroprotection in adults after cardiopulmonary resuscitation. Cochrane Database of Systematic Reviews 2009. PMID</ref>

	The HACA Trial (Hypothermia after Cardiac Arrest) randomized patients after witness Ventricular Fibrillation (VF) and pulseless Ventricular Tachycardia (VT) to 32-34°C Hypothermia. There was a significant patient centered outcome and 6 month mortality decrease in the hypothermia group. A later trial by [[Bernard Hypothermia Trial\|Bernard et. al.]] demonstrated similar benefit and subsequent Cochrane reviews and the [[EBQ:TTM Trial\|TTM Trial]] (33°C vs 33°C) found similar mortality and morbidity benefits.<ref name="Cochrane"></ref>		*The HACA Trial (Hypothermia after Cardiac Arrest) randomized patients after witness Ventricular Fibrillation (VF) and pulseless Ventricular Tachycardia (VT) to 32-34°C Hypothermia. There was a significant patient centered outcome and 6 month mortality decrease in the hypothermia group. A later trial by [[Bernard Hypothermia Trial\|Bernard et. al.]] demonstrated similar benefit and subsequent Cochrane reviews and the [[EBQ:TTM Trial\|TTM Trial]] (33°C vs 33°C) found similar mortality and morbidity benefits.<ref name="Cochrane"></ref>

	*Standard care established by the ACCF/AHA 2013 guidelines, recommend therapeutic hypothermia for any comatose patient with a STEMI and out of hospital cardiac arrest from VF or puleless VT<ref>http://www.ncbi.nlm.nih.gov/pubmed/23256913</ref>		*Standard care established by the ACCF/AHA 2013 guidelines, recommend therapeutic hypothermia for any comatose patient with a STEMI and out of hospital cardiac arrest from VF or puleless VT<ref>http://www.ncbi.nlm.nih.gov/pubmed/23256913</ref>

	==Study Design==		==Study Design==
	*Randomized, Multicenter, unblinded treatment with blinded final outcome assessment.		*Randomized, Multicenter, unblinded treatment with blinded final outcome assessment.

Ostermayer at 16:12, 1 October 2014

2014-10-01T16:12:04Z

← Older revision		Revision as of 16:12, 1 October 2014
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	[[Category:Neuro]]		[[Category:Neuro]]
	[[Category:Critical Care]]		[[Category:Critical Care]]
			[[Category:Featured]]

Ostermayer: /* See Also */

2014-10-01T16:09:55Z

Ostermayer: /* See Also */

2014-10-01T16:09:30Z

← Older revision		Revision as of 16:09, 1 October 2014
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	==See Also==		==See Also==
	*[[Therapeutic Hypothermia]]		{{Hypothermia Cardia Arrest Links}}
	*[[EBQ:TTM Trial\|TTM Trial]]
	*[[Cardiac Arrest]]

	==Sources==		==Sources==