“…Indeed, whether fever contributes to poor neurological outcome or is just a marker of severe brain injury remains unknown. In the attempt to provide a response to this knowledge gap, the BOX trial randomly assigned comatose patients after OHCA of presumed cardiac cause to a device-based temperature control for either 36 or 72 h [ 63 ]. More specifically, the temperature was targeted at 36 °C for 24 h followed by a target of 37 °C for either 12 or 48 h (i.e., the total intervention times were 36 or 72 h).…”
Section: Results and Discussion Of 2022 Rctsmentioning
confidence: 99%
“…The conclusion was that a stepwise antiseizure treatment did not yield any benefit in terms of outcome, despite suppressing the malignant EEG pattern. Figure 4 Number of randomized clinical trials published in 2022 for each link of the chain of survival [ 4 , 9 , 15 , 17 , 22 , 30 , 38 , 45 , 51 , 52 , 60 , 63 , 65 ]. …”
Section: Results and Discussion Of 2022 Rctsmentioning
confidence: 99%
“… Number of randomized clinical trials published in 2022 for each link of the chain of survival [ 4 , 9 , 15 , 17 , 22 , 30 , 38 , 45 , 51 , 52 , 60 , 63 , 65 ]. …”
Section: Results and Discussion Of 2022 Rctsmentioning
Cardiac arrest, one of the leading causes of death, accounts for numerous clinical studies published each year. This review summarizes the findings of all the randomized controlled clinical trials (RCT) on cardiac arrest published in the year 2022. The RCTs are presented according to the following categories: out-of- and in-hospital cardiac arrest (OHCA, IHCA) and post-cardiac arrest care. Interestingly, more than 80% of the RCTs encompassed advanced life support and post-cardiac arrest care, while no studies focused on the treatment of IHCA, except for one that, however, explored the temperature control after resuscitation in this population. Surprisingly, 9 out of 11 RCTs led to neutral results demonstrating equivalency between the newly tested interventions compared to current practice. One trial was negative, showing that oxygen titration in the immediate pre-hospital post-resuscitation period decreased survival compared to a more liberal approach. One RCT was positive and introduced new defibrillation strategies for refractory cardiac arrest. Overall, data from the 2022 RCTs discussed here provide a solid basis to generate new hypotheses to be tested in future clinical studies.
“…Indeed, whether fever contributes to poor neurological outcome or is just a marker of severe brain injury remains unknown. In the attempt to provide a response to this knowledge gap, the BOX trial randomly assigned comatose patients after OHCA of presumed cardiac cause to a device-based temperature control for either 36 or 72 h [ 63 ]. More specifically, the temperature was targeted at 36 °C for 24 h followed by a target of 37 °C for either 12 or 48 h (i.e., the total intervention times were 36 or 72 h).…”
Section: Results and Discussion Of 2022 Rctsmentioning
confidence: 99%
“…The conclusion was that a stepwise antiseizure treatment did not yield any benefit in terms of outcome, despite suppressing the malignant EEG pattern. Figure 4 Number of randomized clinical trials published in 2022 for each link of the chain of survival [ 4 , 9 , 15 , 17 , 22 , 30 , 38 , 45 , 51 , 52 , 60 , 63 , 65 ]. …”
Section: Results and Discussion Of 2022 Rctsmentioning
confidence: 99%
“… Number of randomized clinical trials published in 2022 for each link of the chain of survival [ 4 , 9 , 15 , 17 , 22 , 30 , 38 , 45 , 51 , 52 , 60 , 63 , 65 ]. …”
Section: Results and Discussion Of 2022 Rctsmentioning
Cardiac arrest, one of the leading causes of death, accounts for numerous clinical studies published each year. This review summarizes the findings of all the randomized controlled clinical trials (RCT) on cardiac arrest published in the year 2022. The RCTs are presented according to the following categories: out-of- and in-hospital cardiac arrest (OHCA, IHCA) and post-cardiac arrest care. Interestingly, more than 80% of the RCTs encompassed advanced life support and post-cardiac arrest care, while no studies focused on the treatment of IHCA, except for one that, however, explored the temperature control after resuscitation in this population. Surprisingly, 9 out of 11 RCTs led to neutral results demonstrating equivalency between the newly tested interventions compared to current practice. One trial was negative, showing that oxygen titration in the immediate pre-hospital post-resuscitation period decreased survival compared to a more liberal approach. One RCT was positive and introduced new defibrillation strategies for refractory cardiac arrest. Overall, data from the 2022 RCTs discussed here provide a solid basis to generate new hypotheses to be tested in future clinical studies.
“…Attention to fever prevention must be paid for at least 48 h after finalization of rewarming, and for at least 72 h after ROSC as general practice. However, a Danish RCT showed that maintaining normothermia for over 48 h, when compared to 12 h following rewarming from initial temperature control at 36 °C, failed to confer any benefit in reducing mortality or significant disability [ 74 ]. Temperature fluctuations, if not actively controlled, can be extremely labile and ultimately detrimental to outcomes [ 48 ].…”
Cardiac arrest (CA) is a critical public health issue affecting more than half a million Americans annually. The main determinant of outcome post-CA is hypoxic-ischemic brain injury (HIBI), and temperature control is currently the only evidence-based, guideline-recommended intervention targeting secondary brain injury. Temperature control is a key component of a post-CA care bundle; however, conflicting evidence challenges its wide implementation across the vastly heterogeneous population of CA survivors. Here, we critically appraise the available literature on temperature control in HIBI, detail how the evidence has been integrated into clinical practice, and highlight the complications associated with its use and the timing of neuroprognostication after CA. Future clinical trials evaluating different temperature targets, rates of rewarming, duration of cooling, and identifying which patient phenotype benefits from different temperature control methods are needed to address these prevailing knowledge gaps.
“…The BOX (Blood pressure and OXygenation targets after out-of-hospital cardiac arrest) randomized clinical trial with a 2-by-2 factorial design was performed at two Danish tertiary hospitals from 2017 to 2022 [ 7 – 9 ]. Two blood pressure targets, two oxygenation targets, and the duration of fever management with a device were compared in 789 comatose out-of-hospital cardiac arrest patients.…”
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
