Efficacy of the cooling method for targeted temperature management in post-cardiac arrest patients: A systematic review and meta-analysis

Kim, Jae Guk; Ahn, Chiwon; Shin, Hyungoo; Kim, Wonhee; Lim, Taeho; Jang, Bo‐Hyoung; Cho, Youngsuk; Choi, Kyu Sun; Lee, Juncheol; Na, MinKyun

doi:10.1016/j.resuscitation.2019.12.025

Cited by 18 publications

(19 citation statements)

References 57 publications

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“…The use of a high-quality TTM system equipped with automatic temperature feedback systems is recommended to manage targeted temperatures with minimal uctuations [1]. If body temperatures are not adequately monitored and adjusted, the bene cial effects of TTM may be compromised due to delays in TTM induction, unintentional overcooling or hyperthermia, or spontaneous and rapid rewarming [1,20].…”

Section: Discussionmentioning

confidence: 99%

Optimal Targeted Temperature in Targeted Temperature Management without Automated Devices Using a Temperature Feedback System: A Prospective, Multicenter Observational Study (KoCARC Registry)

Kong

You

Lee

et al. 2021

Preprint

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Background: Targeted temperature management (TTM) at 32ºC–36ºC improves patient outcomes following out-of-hospital cardiac arrest (OHCA). TTM using automated temperature management devices with feedback systems (TFDs) is recommended, but the equipment is often unavailable. This study aimed to investigate therapeutic relations between targeted temperatures and TFDs on the outcomes of OHCA patients with TTM. To the best of our knowledge, this is the first study to identify the optimal targeted temperature in TTM without TFD with regards to neurological outcomes in OHCA patients. Methods: This prospective multicenter study analyzed nontraumatic OHCA registry data between October 2015 and June 2020 from 62 institutions. Patients were classified into four groups based on targeted temperatures and TFD implementation: TTM at 36ºC with TFD (36TFD), TTM at 33ºC with TFD (33TFD), TTM at 36°C without TFD (36NTFD), and TTM at 33°C without TFD (33TNFD). Clinical outcomes were neurological status at discharge. Results: A total of 938 patients were included in the analysis. A significant interaction was found between targeted temperatures and TFD use on neurological outcomes (P=0.032). There was an independent association between the 33NTFD patients with the least favorable neurological outcomes among the four groups after adjustment for covariates. However, no significant differences were observed in neurological outcomes among the 36TFD, 33TFD, and 36NTFD groups after adjusting for covariates. Compared to 33NTFD patients, 36NTFD patients exhibited significantly higher adjusted ORs for favorable neurological status (OR: 4.28, 95% CI: 1.50–12.16, P<0.01). Conclusions: In OHCA patients receiving TTM without TFDs, the adjusted predicted probability of favorable neurological outcomes at hospital discharge was greater for TTM at 36°C than that at 33°C. The 36NTFD group displayed similar therapeutic effect as the TFD groups. This suggests that a TTM of 36°C rather than 33°C is associated with more favorable neurological outcomes if TFDs are unavailable.

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Section: Discussionmentioning

confidence: 99%

Optimal Targeted Temperature in Targeted Temperature Management without Automated Devices Using a Temperature Feedback System: A Prospective, Multicenter Observational Study (KoCARC Registry)

Kong

You

Lee

et al. 2021

Preprint

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“…A recent meta-analysis focusing on the clinical application of advanced surface cooling using hydrogel found no significant difference compared to endovascular cooling in terms of survival and neurological outcome. 55 However, other detailed analyses seemed to favor endovascular cooling. A retrospective cohort of 132 patients showed that endovascular cooling with cold saline was associated with faster time to target temperature and better temperature maintenance.…”

Section: The Cooling Methods Of Ttmmentioning

confidence: 99%

Targeted temperature management and early neuro-prognostication after cardiac arrest

Chen

Lachance

Gao

et al. 2021

J Cereb Blood Flow Metab

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Targeted temperature management (TTM) is a recommended neuroprotective intervention for coma after out-of-hospital cardiac arrest (OHCA). However, controversies exist concerning the proper implementation and overall efficacy of post-CA TTM, particularly related to optimal timing and depth of TTM and cooling methods. A review of the literature finds that optimizing and individualizing TTM remains an open question requiring further clinical investigation. This paper will summarize the preclinical and clinical trial data to-date, current recommendations, and future directions of this therapy, including new cooling methods under investigation. For now, early induction, maintenance for at least 24 hours, and slow rewarming utilizing endovascular methods may be preferred. Moreover, timely and accurate neuro-prognostication is valuable for guiding ethical and cost-effective management of post-CA coma. Current evidence for early neuro-prognostication after TTM suggests that a combination of initial prediction models, biomarkers, neuroimaging, and electrophysiological methods is the optimal strategy in predicting neurological functional outcomes.

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Section: En Pacientes Adultos Con Paro Cardiaco La Inducción De Hipotermia Con Dispositivos De Enfriamiento Endovascular Luego Del Retornunclassified

“…En la revisión sistemática y metaanálisis de Kim, et al 69 (2 estudios controlados aleatorizados y 7 estudios de observación, 4,401 pacientes) la inducción de hipotermia terapéutica con dispositivos de enfriamiento endovascular resultó inferior a dispositivos de enfriamiento de superficie en riesgo de hipopotasemia (RR: 1.04-1.88), y no diferente en riesgo de infecciones (RR: 0.94-1.10), arritmias (RR: 0.76-1.39), convulsiones (RR: 0.73-1.26), sangrado (RR: 0.66-2.35), insuficiencia renal (RR: 0.55-1.47), e hiperpotasemia (RR: 0.26-7.78) (Anexo I, Tabla I.23).…”

Section: En Pacientes Adultos Con Paro Cardiaco La Inducción De Hipotermia Con Dispositivos De Enfriamiento Endovascular Luego Del Retornunclassified

Consenso Latinoamericano de Reanimación Cardiopulmonar

AUTORES¹,

García²,

Grajales-López³

et al. 2021

REIE

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Desde épocas remotas la humanidad ha intentado revertir la muerte, tal como en el episodio mitológico egipcio cuando Isis devolvió la vida a Osiris respirando dentro de su boca. A lo largo de la historia se aplicaron con este fin diversos métodos, iniciando la reanimación cardiopulmonar moderna en la década de 1950. Al evaluar las causas de muerte, la enfermedad cardiovascular continúa siendo la que ocupa el primer lugar. Aproximadamente la mitad se deben a enfermedad cardiaca isquémica, las cuales ocurren de manera súbita en hasta el 50% de los casos. A su vez, la enfermedad cardiaca isquémica es la causa del 80% de las muertes súbitas. Se estima que cada minuto mueren en el mundo 11 personas por paro cardiaco súbito, la mayoría adultos. En hombres es dos veces más frecuente que en mujeres y se presenta a una edad promedio de siete años menos. El 75-80% de los paros cardiacos extrahospitalarios (PCR-EH) ocurren en el domicilio de la víctima. El ritmo inicial del paro cardiaco puede ser arritmia ventricular (fibrilación o taquicardia ventriculares sin pulso), actividad eléctrica sin pulso o asistolia. El 20-38% de los paros cardiacos se presentan con arritmia ventricular, siendo más frecuente en eventos presenciados por testigos que en no presenciados. Se estima que la sobrevida al PCR-EH es del 2-22%. Lati-

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Efficacy of the cooling method for targeted temperature management in post-cardiac arrest patients: A systematic review and meta-analysis

Cited by 18 publications

References 57 publications

Optimal Targeted Temperature in Targeted Temperature Management without Automated Devices Using a Temperature Feedback System: A Prospective, Multicenter Observational Study (KoCARC Registry)

Optimal Targeted Temperature in Targeted Temperature Management without Automated Devices Using a Temperature Feedback System: A Prospective, Multicenter Observational Study (KoCARC Registry)

Targeted temperature management and early neuro-prognostication after cardiac arrest

Consenso Latinoamericano de Reanimación Cardiopulmonar

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