A multicentre randomized pilot trial on the effectiveness of different levels of cooling in comatose survivors of out-of-hospital cardiac arrest: the FROST-I trial
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To obtain initial data on the effect of different levels of targeted temperature management (TTM) in out-of-hospital cardiac arrest (OHCA).
We designed a multicentre pilot trial with 1:1:1 randomization to either 32 °C (n = 52), 33 °C (n = 49) or 34 °C (n = 49), via endovascular cooling devices during a 24-h period in comatose survivors of witnessed OHCA and initial shockable rhythm. The primary endpoint was the percentage of subjects surviving with good neurologic outcome defined by a modified Rankin Scale (mRS) score of ≤ 3, blindly assessed at 90 days.
At baseline, different proportions of patients who had received defibrillation administered by a bystander were assigned to groups of 32 °C (13.5%), 33 °C (34.7%) and 34 °C (28.6%; p = 0.03). The percentage of patients with an mRS ≤ 3 at 90 days (primary endpoint) was 65.3, 65.9 and 65.9% in patients assigned to 32, 33 and 34 °C, respectively, non-significant (NS). The multivariate Cox proportional hazards model identified two variables significantly related to the primary outcome: male gender and defibrillation by a bystander. Among the 43 patients who died before 90 days, 28 died following withdrawal of life-sustaining therapy, as follows: 7/16 (43.8%), 10/13 (76.9%) and 11/14 (78.6%) of patients assigned to 32, 33 and 34 °C, respectively (trend test p = 0.04). All levels of cooling were well tolerated.
There were no statistically significant differences in neurological outcomes among the different levels of TTM. However, future research should explore the efficacy of TTM at 32 °C.
Clinical trial registration
ClinicalTrials.gov unique identifier: NCT02035839 (http://clinicaltrials.gov).
KeywordsBrain injury Cardiac arrest Post-cardiac arrest syndrome Resuscitation Sudden death Targeted temperature management
This work was supported by ZOLL Medical Corporation, Inc. (USA).
Compliance with ethical standards
Conflict of interest
E. Lopez-de-Sa: Research Grant; Modest; ZOLL Medical Corporation, Inc. (USA), Boehringer Ingelheim, Servier. Speakers Bureau; Modest; Daiichi Sankyo, Rovi, Servier, BARD. Consultant/Advisory Board; Modest; AstraZeneca. M. Juarez: Research Grant; Modest; ZOLL Medical Corporation, Inc. (USA). E. Armada: Research Grant; Modest; ZOLL Medical Corporation, Inc. (USA). J.C. Sanchez-Salado: None. P.L. Sanchez: None. P. Loma-Osorio: Research Grant; Modest; ZOLL Medical Corporation, Inc. (USA), Sanofi. Honoraria; Modest; Sanofi, Daiichi Sankyo, AstraZeneca, Pfizer. A. Sionis: None. M.C. Monedero: Research Grant; Modest; ZOLL Medical Corporation, Inc. (USA), Lilly. M. Martinez-Selles: Research Grant; Modest; ZOLL Medical Corporation, Inc. (USA). M. Sanchez-Gracia: None. A. Ariza: Research Grant; Modest; ZOLL Medical Corporation, Inc. (USA). A. Uribarri: Research Grant; Modest; ZOLL Medical Corporation, Inc. (USA). J.M. Garcia-Acuña: None. P. Villa: None. P.J. Perez: Research Grant; Modest; ZOLL Medical Corporation, Inc. (USA). C. Storm: Research Grant; Significant; Fresenius Deutschland. Speakers Bureau; Modest; Philips, C.R. BARD, ZOLL Medical Corporation, Inc., Medivance, Covidien, Nonin Medical, German Heart Foundation. A. Dee: Employment; Significant; ZOLL Medical Corporation, Inc. J.L. Lopez-Sendon: Research Grant: Modest; Sanofi, Servier, AstraZeneca, GlaxoSmithKline, Menarini, Novartis. Consultant/Advisory Board; Modest; Boehringer Ingelheim, Daiichi Sankyo. Other; Modest; Servier.
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