Impact of rewarming rate on interleukin-6 levels in patients with shockable cardiac arrest receiving targeted temperature management at 33 °C: the ISOCRATE pilot randomized controlled trial

Critical Care

Gwenhael Colin¹  Elie Guichard²  Amélie Le Gouge²  Jean-Claude Lacherade³  Caroline Pouplet³  Stéphanie Martin³  Jean Reignier⁴  Jean-Baptiste Lascarrou⁵ 

[1] AfterROSC Network, Paris, France;Médecine Intensive Reanimation, District Hospital Center, La Roche-sur-Yon, France;INSERM CIC1415, CHRU de Tours, Tours, France;Médecine Intensive Reanimation, District Hospital Center, La Roche-sur-Yon, France;Médecine Intensive Reanimation, University Hospital Center, 30 Boulevard Jean Monnet, 44093, Nantes Cedex 1, France;Médecine Intensive Reanimation, University Hospital Center, 30 Boulevard Jean Monnet, 44093, Nantes Cedex 1, France;Paris Cardiovascular Research Center, INSERM U970, Paris, France;AfterROSC Network, Paris, France;

关键词: Cardiac arrest;    Targeted temperature management;    Therapeutic hypothermia;   

DOI  :  10.1186/s13054-021-03842-9

来源: Springer

【 摘 要 】

PurposeWhile targeted temperature management (TTM) has been recommended in patients with shockable cardiac arrest (CA) and suggested in patients with non-shockable rhythms, few data exist regarding the impact of the rewarming rate on systemic inflammation. We compared serum levels of the proinflammatory cytokine interleukin-6 (IL6) measured with two rewarming rates after TTM at 33 °C in patients with shockable out-of-hospital cardiac arrest (OHCA).MethodsISOCRATE was a single-center randomized controlled trial comparing rewarming at 0.50 °C/h versus 0.25 °C/h in patients coma after shockable OHCA in 2016–2020. The primary outcome was serum IL6 level 24–48 h after reaching 33 °C. Secondary outcomes included the day-90 Cerebral Performance Category (CPC) and the 48-h serum neurofilament light-chain (NF-L) level.ResultsWe randomized 50 patients. The median IL6 area-under-the-curve was similar between the two groups (12,389 [7256–37,200] vs. 8859 [6825–18,088] pg/mL h; P = 0.55). No significant difference was noted in proportions of patients with favorable day-90 CPC scores (13/25 patients at 0.25 °C/h (52.0%; 95% CI 31.3–72.2%) and 13/25 patients at 0.50 °C/h (52.0%; 95% CI 31.3–72.2%; P = 0.99)). Median NF-L levels were not significantly different between the 0.25 °C/h and 0.50 °C/h groups (76.0 pg mL, [25.5–3074.0] vs. 192 pg mL, [33.6–4199.0]; P = 0.43; respectively).ConclusionIn our RCT, rewarming from 33 °C at 0.25 °C/h, compared to 0.50 °C/h, did not decrease the serum IL6 level after shockable CA. Further RCTs are needed to better define the optimal TTM strategy for patients with CA.Trial registration ClinicalTrials.gov, NCT02555254. Registered September 14, 2015.Take-Home Message: Rewarming at a rate of 0.25 °C/h, compared to 0.50 °C, did not result in lower serum IL6 levels after achievement of hypothermia at 33 °C in patients who remained comatose after shockable cardiac arrest. No associations were found between the slower rewarming rate and day-90 functional outcomes or mortality.140-character Tweet: Rewarming at 0.25 °C versus 0.50 °C did not decrease serum IL6 levels after hypothermia at 33 °C in patients comatose after shockable cardiac arrest.

【 授权许可】

CC BY