Duration of Therapeutic Hypothermia After Out-of-Hospital Cardiac Arrest: The ICECAP Randomized Clinical…

Cohort studyJAMA· Aug 2026

Duration of Therapeutic Hypothermia After Out-of-Hospital Cardiac Arrest: The ICECAP Randomized Clinical Trial.

William J Meurer, Sharon D Yeatts, Romergryko G Geocadin … SIREN Investigators

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Resuscitation & Cardiac ArrestCohort studyTreatmentQ1IF 8.0

Six-hour cooling was about as likely optimal as longer durations after cardiac arrest.

Duration of Therapeutic Hypothermia After Out-of-Hospital Cardiac Arrest: The ICECAP Randomized Clinical Trial.

William J Meurer … SIREN Investigators

JAMA · Aug 2026 · Q1 in General Medicine

Background

IMPORTANCE: Therapeutic hypothermia is widely used for neuroprotection following cardiac arrest, but clinical trials have not consistently demonstrated improved neurological outcomes, and the optimal duration of cooling remains uncertain.

Purpose

To determine the duration of therapeutic hypothermia that maximizes neurological recovery in comatose survivors of out-of-hospital cardiac arrest.

Methods

DESIGN, SETTING, AND PARTICIPANTS: Multicenter, randomized, adaptive-allocation clinical trial conducted at 71 hospitals in the US.

n = 1158 patients

Results

0.51

6 hours cooling worked about as well as longer courses

n = 1158 patients

More results

Participants had a median age of 61 (IQR, 50-70) years and 39.6% were female.

The trial met a prespecified stopping rule at the interim analysis.

Results were similar in the shockable rhythm cohort.

No differences were observed in secondary outcomes or mortality across cooling durations.

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Conclusion

Among comatose survivors of out-of-hospital cardiac arrest treated with therapeutic hypothermia at 33 °C, increasing cooling duration did not improve neurological outcomes.

Duration of Therapeutic Hypothermia After Out-of-Hospital Cardiac Arrest: The ICECAP Randomized Clinical Trial.

Duration of Therapeutic Hypothermia After Out-of-Hospital Cardiac Arrest: The ICECAP Randomized Clinical Trial.

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