Transcript Video Late Breaking - HYPO-ECMO Cardiac Arrest Outcomes < Back to Summit23 Expansion to Temperature Control Late Breaking - HYPO-ECMO Cardiac Arrest Outcomes Presented by Professor Bruno Levy And welcome back to the last session of this second day. And indeed, we go back to the title of this summit. So expansion to Temperature control from T So the core of this meeting, I will co chair this session with Thomas fell and I think I have to continue from there. Yes. And now another new face, Bruno back on stage. Um He's back to give us AAA presentation on uh on um Hypo Emo and uh the late breaking news on that. Thanks Bruno. Thank you very much. So, uh some data uh uh from the Hypo Emo study, the study was uh presented uh uh last year just to remind uh we compare moderate hypothermia uh 2324 degrees to a three normal theia. And you can see how we implement TTM. So the patients were included. And for a patient in the hypothermia group, the temperature was maintained mainly with the heat exchanger of the ECMO device. Hypothermia was maintained for 24 hours and the patient was progressively r during 24 hours. And we maintain the temperature at normal term during, for a total duration of 92 hours. And in the normal term group, we maintain a temperature between 36 for patients with cardiac arrest and 37 for all the patients. The primary endpoint was mortality and we also use a lot of secondary endpoints and mainly a composite score, which is a composite score of deaf cardiac transplantation, stroke or escalation to LVI. And the patient will follow at day 3060 after six months, it was a multi center around the mice control study. And the inclusion were very simple patient with cardio shock, treated with ECMO for less than six hours and intubated in it because we want to use hypothermia and hypothermia is difficult to unconsciously non sedated and non intubating patients. Please have a look at the non inclusion criteria which are very important to consider. Especially we do not, we do not include patients out of hospital cardiac arrest that might need some pr we don't consider patient for in which was used for V or transplantation, uncontrolled bleeding. A moon patient could poison cardiotoxic drugs. And we do not, we did not include patients with cardio recitation duration higher than 45 minutes. And we know you know the main results, these results was in accordance with the statistical plan and we will discuss this point after the review of the Jama also to expose our result in terms of risks difference. There is a very important difference. If we have used the ri difference study would have been positive So we have some discussion with Jamma Roy. He said that the study is not negative but the study is inconclusive. And they also highlight the fact that the studio is also compatible with large through survival positive effects. Up to 1919 lives safe for every 100 patients treated. And uh this uh result was highlighted in the uh high risk uh difference. So we uh performed some uh post talk uh analysis. Uh First one, which I hope will be published soon is uh secondary analysis I using a win ratio, which is a statistical methods, especially to consider the composite composite outcome. And as you can observe, there is a very strong signal in favor of moderate hypothermia at 30 days, 60 days and after six months, uh if we consider patients with CAAC arrest, which is the topic of uh of the day. Uh First on the left part of the slide, you can see the cultural indications uh for the inclusion of hypo emos. And if we observe, we have a panel of patients that are very, very, that were very, very selected. And the main characteristic of the cat was in hospital cataract but means a patient with a myocardial infarction and cat in the coronary ory room. For example, it's of course witness catalas and of course highly specialized cardiac arrest because mothers are in the hospital uh ECMO implantation during cardiac uh 36% checkable rate in half of the patient Nero was very low. And uh of course, epinephrine was used in this patient. And you can see first two different uh result. The first one here is that despite some signal, there is no uh big difference uh for the patient uh considering they had a card or not a cat. So in selected patients, cardiac arrest do not, did not appear to be very, very bad in in this uh patient. And please have a look at this curve. And you can see that the effects of hypo hypothermia seems very important in the group of patients with cardiac. It's the blue one, the upper part of the graph when compared to the other graft. So patient with cardiac arrest, treated with hypothermia seems to be a better prognosis when compared to patients with cardiac arrest, not treated with hypothermia. And for the patient without a car like RS is there were no differences for the use of the efficiency of hypothermia and maybe some potential explanation on the left part curve, the curve. And you can see that hypothermia was very, very fast, we obtained in a very fast manner when compared for example, the TM two. And as highlighted by the previous speaker yesterday, you have to add two hours. So I I was obtaining the TM two after 9 to 11 hours and it was very, very uh rapid in the hypothermia. And we also found the same type of results in de novo art failure versus uh for example, a patient with cardio and we found the same result because uh de Noval failure patient had another incidence of uh card. So based on the primary result, the positive result of the composite score, the bier analysis which was published in the Jama paper, which was also a post doc analysis, the ring ratio and the post O student card alet. It is likely that moderate apo in emo patient via patient treated for card improved survival. In this patient, we are intubated and comparatively to drug and new device research, hypothermia seems to be inexpensive or cheap and very simple to implement in the real life. So and this is not in my presentation today, but we did not observe as highlighted by yesterday, any safety concern especially of course for the rate but also for the infectious complication and for bleeding. So we think that in va patient, a patient and to it, which is not the case for all patients, we cannot extract and treat it via amo it seem reasonable to use moate hypothermia in the way we use for this. Thank you very much for your attention. Created by
