USA: A recent study published in JAMA has shown that extending the duration of therapeutic hypothermia at 33°C in comatose survivors of out-of-hospital cardiac arrest did not improve neurological outcomes compared with shorter cooling durations. The findings suggest that prolonged cooling provides no additional neurological benefit in these patients.

The findings are from the ICECAP (Influence of Cooling Duration on Efficacy in Cardiac Arrest Patients) Randomized Clinical Trial, led by William J. Meurer from the Department of Emergency Medicine and SIREN Clinical Coordinating Center, University of Michigan, Ann Arbor, and colleagues. The researchers sought to identify the optimal duration of therapeutic hypothermia that maximizes neurological recovery after out-of-hospital cardiac arrest, an area where previous clinical studies have yielded inconsistent results despite the widespread use of cooling therapy for
neuroprotection.
The multicenter, randomized, adaptive clinical trial was conducted across 71 hospitals in the United States and enrolled adults who remained unconscious after out-of-hospital cardiac arrest. Eligible participants achieved a body temperature below 34°C within four hours of cardiac arrest and had treatment initiated using a temperature-control device. Patients were enrolled between June 2020 and June 2025.
Participants were assigned to therapeutic hypothermia at 33°C for one of 10 different cooling durations: 6, 12, 18, 24, 30, 36, 42, 48, 60, or 72 hours. The trial initially randomized patients equally to 12-, 24-, and 48-hour cooling periods before switching to a response-adaptive allocation strategy that preferentially assigned participants to durations most likely to be optimal. Neurological recovery at 90 days served as the primary outcome and was evaluated using a weighted modified Rankin Scale score within a Bayesian duration-response model.
A total of 1,158 patients were randomized, including 883 with nonshockable cardiac rhythms and 275 with shockable rhythms. Participants had a median age of 61 years, and 39.6% were women. The study reached a prespecified stopping criterion during an interim analysis because the accumulated evidence sufficiently addressed the primary research question.
The trial revealed the following findings:
  • Among patients with nonshockable rhythms, 6 hours had an approximately 51% probability of being the shortest cooling duration that achieved maximal neurological recovery.
  • Similar results were observed in patients with shockable rhythms, with longer cooling durations providing no additional improvement in neurological outcomes.
  • No significant differences were found in secondary clinical outcomes or mortality across the different therapeutic hypothermia durations.
  • Extending therapeutic hypothermia beyond six hours did not demonstrate superior effectiveness compared with shorter cooling durations, irrespective of the initial cardiac rhythm.
The researchers concluded that extending therapeutic hypothermia at 33°C does not improve neurological outcomes in comatose survivors of out-of-hospital cardiac arrest. The findings indicate that shorter cooling durations are sufficient to achieve maximal neurological recovery, with no added clinical benefit from prolonged cooling.
Reference:
Meurer WJ, Yeatts SD, Geocadin RG, et al. Duration of Therapeutic Hypothermia After Out-of-Hospital Cardiac Arrest: The ICECAP Randomized Clinical Trial. JAMA. Published online August 05, 2026. doi:10.1001/jama.2026.10247
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Article Source : JAMA

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Medha Baranwal

Medha Baranwal holds a Bachelor’s degree in Biomedical Sciences from the University of Delhi and a Master’s degree in Biotechnology from Amity University. Since May 2018, she has been contributing to Medical Dialogues, writing and editing medical news articles that translate complex research into clear, accessible information for healthcare professionals.

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