Aim: To determine the safety and feasibility of an early (12 h) waking and extubation protocol for out-of-hospital cardiac arrest (OHCA) patients receiving targeted temperature management (TTM). Methods: This was a single-centre, prospective, non-randomised, observational, safety and feasibility pilot study which included successfully resuscitated OHCA patients, of presumed cardiac cause. Inclusion criteria were: OHCA patients aged over 18 years with a return of spontaneous circulation, who were going to receive TTM33 (TTM at 33 degrees C for 24 h and prevention of hyperthermia for 72 h) as part of their post cardiac arrest care. Clinical stability was measured against physiological and neurological parameters as well as clinical assessment. Results: 50 consecutive patients were included (median age 65.5 years, 82% male) in the study. Four (8%) patients died within the first twelve hours and were excluded from the final cohort (n = 46). Twenty-three patients (46%) were considered clinically stable and suitable for early waking based on the intention to treat analysis; 12 patients were extubated early based on a variety of clinical factors (21.4 +/- 8.6 h) whilst continuing to receive TTM33 with a mean core temperature of 34.2 degrees C when extubated. Of these, five patients were discharged from the intensive care unit (ICU) <48 h after admission with a mean ICU length of stay 1.8 +/- 0.4 days. Twenty-eight patients (56%) were discharged from the ICU with a modified Rankin Score of 0-2. The overall intra-hospital mortality was 50% (n = 25). Conclusions: It is safe and feasible to wake selected comatose OHCA patients at 12 h, allowing for earlier positive neuro-prognostication and reduced ICU stay.

Mild therapeutic hypothermia (MTH 33°C) post out-of-hospital cardiac arrest (OHCA) is widely accepted as standard of care. However, uncertainty remains around the dose and therapy duration. OHCA patients are usually kept sedated±paralyzed and ventilated for the first 24-36 hours, which allows for targeted temperature management, but makes neurological prognostication challenging. The aim of this study is to investigate the feasibility and safety of assessing the unconscious OHCA patient after 12 hours for early waking/extubation while continuing to provide MTH for 24 hours, and fever prevention for 72 hours by using an intravenous temperature management (IVTM) system and established conscious MTH anti-shiver regimens. This is a single-center, prospective, non-randomized observational study that will compare the results of early awakening (at 12 hours) with historical controls. A total of 50 consecutive unconscious survivors of OHCA, treated with MTH, who meet the Therapeutic Hypothermia and eArly Waking (THAW) inclusion criteria will be enrolled. The patient will receive MTH by using IVTM. After 12 hours of MTH, patients will be assessed by using strict clinical criteria to determine suitability for early waking and extubation. Once awake and extubated, MTH will continue for 24 hours with skin counter-warming and anti-shiver regimen followed fever prevention up to 72 hours. All patients will have serial electroencephalogram (EEG), somatic sensory potential, and neuro-biomarkers performed on admission to intensive care unit, 6 and 12 hours, then every 24 hours until 72 hours. The study has been approved by the National Research Ethics Service, Health Research Authority.

Background Brain injury due to hypoxia, is the most common cause of mortality in patients that have been successfully resuscitated following Cardiac Arrest. The Essex Cardiothoracic Centre (CTC) is a tertiary cardiac centre where all cardiac arrest patients are triaged on arrival within the catheter lab. Here there is access to appropriate PCI and mild therapeutic hypothermia (32°C–33°C), which has increased the survival rate to 67% of all out of hospital arrest patients. Methods and results Previously the CTC has relied upon neurological clinical examination and CT for neurological prognostication, neither of which are appropriate for all patients. In 2014 the ERC and ESICM, suggest the use of a multimodal approach in normothermic and hypothermic patients. We aimed to test the feasibility of setting up a neurological prognostication service using a multimodal approach, with the use of EEG, SSEP and Biomarkers. We believe that by adhering to strict criteria, a multimodal approach can be used safely and effectively in a Cardiac Centre with no on-site neurophysiological support, for more accurate neurological prognostication. The staff have been trained over a 3 month period by external neurophysiology experts to record high quality 20 min EEG, sent to a core lab for analysis and SSEP, interpreted locally. Biomarkers are sent to a reference lab. Conclusion This feasibility study has shown that senior ICU staff can be trained in EEG/SSEP recordings, and can then be interpreted rapidly in a core lab to allow neuro-prognostication to occur in all cardiac centres. This is vital for the up-coming TTM2 trial in 2017.