Therapeutic Hypothermia after Nonshockable Cardiac Arrest: The HYPERION Multicenter, Randomized, Controlled, Assessor-Blinded, Superiority Trial - Archive ouverte HAL Accéder directement au contenu
Article Dans Une Revue Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine Année : 2015

Therapeutic Hypothermia after Nonshockable Cardiac Arrest: The HYPERION Multicenter, Randomized, Controlled, Assessor-Blinded, Superiority Trial

Jean Baptiste Lascarrou
Jérôme Bousser
  • Fonction : Auteur
Pierre Asfar
Jean Paul Gouello
  • Fonction : Auteur
Jean Charles Chakarian
  • Fonction : Auteur
Arnaud Desachy
  • Fonction : Auteur
François Labadie
  • Fonction : Auteur
Dominique Vivier
  • Fonction : Auteur
Sepsis (crics) Group
  • Fonction : Auteur
Hyperion Study Group
  • Fonction : Auteur

Résumé

BACKGROUND: Meta-analyses of nonrandomized studies have provided conflicting data on therapeutic hypothermia, or targeted temperature management (TTM), at 33° C in patients successfully resuscitated after nonshockable cardiac arrest. Nevertheless, the latest recommendations issued by the International Liaison Committee on Resuscitation and by the European Resuscitation Council recommend therapeutic hypothermia. New data are available on the adverse effects of therapeutic hypothermia, notably infectious complications. The risk/benefit ratio of therapeutic hypothermia after nonshockable cardiac arrest is unclear. METHODS: HYPERION is a multicenter (22 French ICUs) trial with blinded outcome assessment in which 584 patients with successfully resuscitated nonshockable cardiac arrest are allocated at random to either TTM between 32.5 and 33.5° C (therapeutic hypothermia) or TTM between 36.5 and 37.5° C (therapeutic normothermia) for 24~hours. Both groups are managed with therapeutic normothermia for the next 24~hours. TTM is achieved using locally available equipment. The primary outcome is day-90 neurological status assessed by the Cerebral Performance Categories (CPC) Scale with dichotomization of the results (1\,+\,2 versus 3\,+\,4\,+\,5). The primary outcome is assessed by a blinded psychologist during a semi-structured telephone interview of the patient or next of kin. Secondary outcomes are day-90 mortality, hospital mortality, severe adverse events, infections, and neurocognitive performance. The planned sample size of 584 patients will enable us to detect a 9% absolute difference in day-90 neurological status with 80% power, assuming a 14% event rate in the control group and a two-sided Type 1 error rate of 4.9%. Two interim analyses will be performed, after inclusion of 200 and 400 patients, respectively. DISCUSSION: The HYPERION trial is a multicenter, randomized, controlled, assessor-blinded, superiority trial that may provide an answer to an issue of everyday relevance, namely, whether TTM is beneficial in comatose patients resuscitated after nonshockable cardiac arrest. Furthermore, it will provide new data on the tolerance and adverse events (especially infectious complications) of TTM at 32.5-33.5° C. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01994772 .

Dates et versions

hal-03156114 , version 1 (02-03-2021)

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Citer

Jean Baptiste Lascarrou, Ferhat Meziani, Amélie Le Gouge, Thierry Boulain, Jérôme Bousser, et al.. Therapeutic Hypothermia after Nonshockable Cardiac Arrest: The HYPERION Multicenter, Randomized, Controlled, Assessor-Blinded, Superiority Trial. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 2015, 23, pp.26. ⟨10.1186/s13049-015-0103-5⟩. ⟨hal-03156114⟩
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