In the propensity-matched cohort, the rate of survival-to-hospital discharge was significantly higher with therapeutic hypothermia (29%) than without it (15%), as was the rate of survival with a favorable neurologic outcome (21% vs 10%). And in a multivariate analysis of factors contributing to positive patient outcomes, the intervention was associated with a 3.5-fold increase in favorable neurologic outcomes. A further analysis of the data showed that therapeutic hypothermia was associated with improved survival, with an odds ratio (OR) of 2.8, the investigators said.
In addition, an analysis of outcomes across various subgroups of patients showed that regardless of the location of their cardiac arrest, patients were consistently more likely to survive to hospital discharge neurologically intact if they received therapeutic hypothermia (OR, 2.1 for out-of-hospital cardiac rest; OR, 4.2 for in-hospital cardiac arrest).
“These results lend support to a broadening of indications for therapeutic hypothermia in comatose post-arrest patients with initial nonshockable rhythms,” Dr Perman and her associates said.
Andexanet reverses anticoagulant effects of factor Xa inhibitors
BY BIANCA NOGRADY
FROM THE AHA SCIENTIFIC SESSIONS
Vitals Key clinical point: Andexanet reverses the anticoagulant effects of factor Xa inhibitors rivaroxaban and apixaban in healthy older adults. Major finding: Andexanet achieved a 92% to 94% reduction in antifactor Xa activity, compared with an 18% to 21% reduction with placebo. Data source: A two-part randomized, placebo-controlled study in 145 healthy individuals. Disclosures: The study was supported by Portola Pharmaceuticals, Bayer, Bristol-Myers Squibb, Johnson & Johnson, and Pfizer. Several authors are employees of Portola, one with stock options and a related patent. Other authors declared grants and personal fees from the pharmaceutical industry, including the study supporters. |
Andexanet alfa has been found to reverse the anticoagulant effects of factor Xa inhibitors rivaroxaban and apixaban, according to a study presented at the American Heart Association scientific sessions and published simultaneously in the November 11 issue of the New England Journal of Medicine.1
In a two-part randomized, placebo-controlled study involving 145 healthy individuals with a mean age of 58 years, patients treated first with apixaban and then given a bolus of andexanet had a 94% reduction in anti-factor Xa activity, compared with a 21% reduction with placebo. Thrombin generation was restored in 100% of patients within 2 to 5 minutes.
In the patients treated with rivaroxaban, treatment with andexanet reduced antifactor Xa activity by 92%, compared to 18% with placebo. Thrombin generation was restored in 96% of participants in the andexanet group, compared with 7% in the placebo group.
Adverse events associated with andexanet were minor, including constipation, feeling hot, or a strange taste in the mouth. The effects of the andexanet also were sustained over the course of a 2-hour infusion in addition to the bolus.1
“The rapid onset and offset of action of andexanet and the ability to administer it as a bolus or as a bolus plus an infusion may provide flexibility with regard to the restoration of hemostasis when urgent factor Xa inhibitor reversal is required,” Dr Deborah M. Siegal of McMaster University, Hamilton, Ontario, Canada and coauthors wrote.
Continuous no better than interrupted chest compressions
BY MARY ANN MOON
FROM THE AHA SCIENTIFIC SESSIONS
Vitals Key clinical point: Continuous chest compressions during CPR didn’t improve survival or neurologic function compared with standard compressions briefly interrupted for ventilation. Major finding: The primary outcome – the rate of survival to hospital discharge – was 9.0% for continuous chest compressions and 9.7% for interrupted compressions, a nonsignificant difference. Data source: A cluster-randomized crossover trial involving 23,711 adults treated by 114 North American EMS agencies for nontraumatic out-of-hospital cardiac arrest. Disclosures: This study was supported by the US National Heart, Lung, and Blood Institute, the US Army Medical Research and Materiel Command, the Canadian Institutes of Health Research, the Institute of Circulatory and Respiratory Health, Defence Research and Development Canada, the Heart and Stroke Foundation of Canada, the American Heart Association, and the Medic One Foundation. Dr Nichol and his associates reported ties to numerous industry sources. |
Continuous chest compressions during CPR failed to improve survival or neurologic function compared with standard chest compressions that are briefly interrupted for ventilation, based on findings in the first large randomized trial to compare the two strategies for out-of-hospital, nontraumatic cardiac arrest.
In a presentation at the American Heart Association scientific sessions, simultaneously published online November 9 in the New England Journal of Medicine, Dr Graham Nichol and his associates analyzed data from the Resuscitation Outcomes Consortium, a network of clinical centers and EMS agencies that have expertise in conducting research on out-of-hospital cardiac arrest.1
Data were analyzed for 23,711 adults treated by 114 EMS agencies affiliated with eight clinical centers across the United States and Canada. These agencies were grouped into 47 clusters that were randomly assigned to perform CPR using either continuous chest compressions (100 per minute) with asynchronous positive-pressure ventilations (10 per minute) or standard chest compressions interrupted for ventilations (at a rate of 30 compressions per two ventilations) at every response to an out-of-hospital cardiac arrest. Twice per year, each cluster crossed over to the other resuscitation strategy, said Dr Nichol of the University of Washington–Harborview Center for Prehospital Emergency Care and Clinical Trial Center in Seattle.