Cooling methods of targeted temperature management and neurological recovery after out-of-hospital cardiac arrest: A nationwide multicenter multi-level analysis

Kim, Ki Hong; Shin, Sang Do; Song, Kyoung Jun; Ro, Young Sun; Kim, Yu Jin; Hong, Ki Jeong; Jeong, Joo; Park, Jeong Ho; Kim, Tae Han; Kong, So Yeon

doi:10.1016/j.resuscitation.2018.01.043

Cited by 31 publications

(26 citation statements)

References 27 publications

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“…The characteristics of the selected studies are summarized in Table 1 and Additional file 1. We identified 4 RCTs (high quality of evidence for two [12, 33] and moderate for two [13, 24]; Additional file 1: Table S3), four prospective studies (low level of evidence [16, 27, 35, 37] with an additional one comparing a prospective cohort with historical controls (very low quality of evidence [36]), and 13 retrospective studies (very low quality of evidence [15, 17, 23, 25, 26, 28–32, 34]), with two of them being a secondary post hoc analysis of RCTs (low quality of evidence [14, 19]). The risk of bias (RB) was low in one study [14] and high for all the others (Tables 2 and 3).…”

Section: Resultsmentioning

confidence: 99%

Effect of different methods of cooling for targeted temperature management on outcome after cardiac arrest: a systematic review and meta-analysis

et al. 2019

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Background Although targeted temperature management (TTM) is recommended in comatose survivors after cardiac arrest (CA), the optimal method to deliver TTM remains unknown. We performed a meta-analysis to evaluate the effects of different TTM methods on survival and neurological outcome after adult CA. Methods We searched on the MEDLINE/PubMed database until 22 February 2019 for comparative studies that evaluated at least two different TTM methods in CA patients. Data were extracted independently by two authors. We used the Newcastle-Ottawa Scale and a modified Cochrane ROB tools for assessing the risk of bias of each study. The primary outcome was the occurrence of unfavorable neurological outcome (UO); secondary outcomes included overall mortality. Results Our search identified 6886 studies; 22 studies ( n = 8027 patients) were included in the final analysis. When compared to surface cooling, core methods showed a lower probability of UO (OR 0.85 [95% CIs 0.75–0.96]; p = 0.008) but not mortality (OR 0.88 [95% CIs 0.62–1.25]; p = 0.21). No significant heterogeneity was observed among studies. However, these effects were observed in the analyses of non-RCTs. A significant lower probability of both UO and mortality were observed when invasive TTM methods were compared to non-invasive TTM methods and when temperature feedback devices (TFD) were compared to non-TFD methods. These results were significant particularly in non-RCTs. Conclusions Although existing literature is mostly based on retrospective or prospective studies, specific TTM methods (i.e., core, invasive, and with TFD) were associated with a lower probability of poor neurological outcome when compared to other methods in adult CA survivors (CRD42019111021). Electronic supplementary material The online version of this article (10.1186/s13054-019-2567-6) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Effect of different methods of cooling for targeted temperature management on outcome after cardiac arrest: a systematic review and meta-analysis

et al. 2019

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“…In terms of EC, 16 studies used the Coolgard/Thermogard system [15] to compare with surface cooling, and the remaining 4 studies [24,28,35,37] did not indicate specific endovascular cooling equipment used. In terms of SC, 6 studies [30,35,36,38,39,41] selected ArcticSun equipment [45] for surface cooling, and other studies included ice packs, cooling blankets, cold liquid infusions, and intracavity perfusion cooling. The core temperature measurements of the 14 studies were performed in the pharynx, esophagus, bladder, rectum, and pulmonary arteries.…”

Section: Selection Of Th Methodsmentioning

confidence: 99%

“…The core temperature measurements of the 14 studies were performed in the pharynx, esophagus, bladder, rectum, and pulmonary arteries. The remaining six studies [22,23,25,30,33,35] did not specify where the temperature measurements were taken (Table 2). In addition, the basic characteristics of the populations included in each study were compared (Table 3).…”

Section: Selection Of Th Methodsmentioning

confidence: 99%

“…There were 16 cohort studies [22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] and 4 RCTs [38][39][40][41]. The analysis included 14 single-center studies and 6 multicenter studies [23,31,33,[35][36][37]. Eleven studies included IHCA patients and OHCA patients, and 9 studies only included OHCA patients.…”

Section: Characterization Of Studies and Patientsmentioning

confidence: 99%

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Effects of endovascular and surface cooling on resuscitation in patients with cardiac arrest and a comparison of effectiveness, stability, and safety: a systematic review and meta-analysis

Liao

Zhou

et al. 2020

Crit Care

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Objectives: This study conducted a meta-analysis to assess the effectiveness, stability, and safety of mild therapeutic hypothermia (TH) induced by endovascular cooling (EC) and surface cooling (SC) and its effect on ICU, survival rate, and neurological function integrity in adult CA patients. Methods: We developed inclusion criteria, intervention protocols, results, and data collection. The results included outcomes during target temperature management as well as ICU stay, survival rate, and neurological functional integrity. The characteristics of the included population and each study were analyzed. Results: Four thousand nine hundred thirteen participants met the inclusion criteria. Those receiving EC had a better cooling efficiency (cooling rates MD = 0.31[0.13, 0.50], p < 0.01; induced cooling times MD = − 90.45[− 167.57, − 13.33], p = 0.02; patients achieving the target temperature RR = 1.60[1.19, 2.15], p < 0.01) and thermal stability during the maintenance phase (maintenance time MD = 2.35[1.22, 3.48], p < 0.01; temperature fluctuation MD = − 0.68[− 1.03, − 0.33], p < 0.01; overcooling RR = 0.33[0.23, 0.49], p < 0.01). There were no differences in ICU survival rate (RR = 1.22[0.98, 1.52], p = 0.07, I 2 = 0%) and hospital survival rate (RR = 1.02 [0.96, 1.09], p = 0.46, I 2 = 0%), but EC reduced the length of stay in ICU (MD = − 1.83[− 3.45, − 0.21], p = 0.03, I 2 = 49%) and improved outcome of favorable neurological function at discharge (RR = 1.15[1.04, 1.28], p < 0.01, I 2 = 0%). EC may delay the hypothermia initiation time, and there was no significant difference between the two cooling methods in the time from the start of patients' cardiac arrest to achieve the target temperature (MD = − 46.64[− 175.86, 82.58]). EC was superior to non-ArcticSun in terms of cooling efficiency. Although there was no statistical difference in ICU survival rate, ICU length of stay, and hospitalization survival rate, in comparison to non-ArcticSun, EC improved rates of neurologically intact survival (RR = 1.16 [1.01, 1.35], p = 0.04, I 2 = 0%).

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“…The former is in the form of cold intravenous fluids and venous catheters, whereas the latter involves direct application of a cooling blanket, gel adhesive, ice, or cold fluid to facilitate cooling. Although the rate of cooling may differ, there have not been differences in neurologic outcome when comparing the methods 56–59 . Importantly, patients are often mildly hypothermic post‐cardiac arrest because of the cooled peripheral circulation returning to the core 33 .…”

Section: Determining the Etiologymentioning

confidence: 99%

State‐of‐the‐art considerations in post‐arrest care

Sonnier

Rittenberger

2020

JACEP Open

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Cardiac arrest has a high rate of morbidity and mortality. Several advances in postcardiac arrest management can improve outcome, but are time-dependent, placing the emergency physician in a critical role to both recognize the need for and initiate therapy. We present a novel perspective of both the workup and therapeutic interventions geared toward the emergency physician during the first few hours of care. We describe how the immediate care of a post-cardiac arrest patient is resource intensive and requires simultaneous evaluation for the underlying cause and intensive management to prevent further end organ damage, particularly of the central nervous system.The goal of the initial focused assessment is to rapidly determine if any reversible causes of cardiac arrest are present and to intervene when possible. Interventions performed in this acute period are aimed at preventing additional brain injury through optimizing hemodynamics, providing ventilatory support, and by using therapeutic hypothermia when indicated. After the initial phase of care, disposition is guided by available resources and the clinician's judgment. Transfer to a specialized cardiac arrest center is prudent in centers that do not have significant support or experience in the care of these patients.

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Cooling methods of targeted temperature management and neurological recovery after out-of-hospital cardiac arrest: A nationwide multicenter multi-level analysis

Cited by 31 publications

References 27 publications

Effect of different methods of cooling for targeted temperature management on outcome after cardiac arrest: a systematic review and meta-analysis

Effect of different methods of cooling for targeted temperature management on outcome after cardiac arrest: a systematic review and meta-analysis

Effects of endovascular and surface cooling on resuscitation in patients with cardiac arrest and a comparison of effectiveness, stability, and safety: a systematic review and meta-analysis

State‐of‐the‐art considerations in post‐arrest care

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