Randomized controlled trial of internal and external targeted temperature management methods in post- cardiac arrest patients

Look, Xinqi; Li, Huihua; Ng, Mingwei; Lim, Eric; Pothiawala, Sohil; Tan, Kenneth; Sewa, Duu Wen; Shahidah, Nur; Pek, Pin Pin; Ong, Marcus Eng Hock

doi:10.1016/j.ajem.2017.07.017

Cited by 45 publications

(46 citation statements)

References 30 publications

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“…Therefore, we believe that the two groups of patients are comparable (Table 3). At the same time, we performed an initial temperature comparison with 7 studies [26,30,31,33,34,40,41] comparing the initial body temperatures of the patient before TH initiation and found no difference in body temperatures between the two groups before cooling (MD = − 0.11 [− 0.34, 0.12], p = 0.37, I 2 = 60%); other studies with unclear initial body temperatures also indicated that there was no significant difference between the two groups in initial body temperature at the time of admission or before the start of TH.…”

Section: Discussionmentioning

confidence: 99%

“…For the safety of patients during TH, some studies [27-29, 31-34, 37, 39-41, 45] analyzed the major adverse events, including arrhythmias [29-32, 34, 37, 39-41, 45], bleeding [24,25,28,31,34,40,41], and infection [29,33,34,40,41]. In addition, pneumonia [28,29,31,34,40] was further independently analyzed.…”

Section: Discussionmentioning

confidence: 99%

“…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%

“…Twenty studies were eventually included. 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].…”

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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Selection Of Th Methodsmentioning

confidence: 99%

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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“…Studies also utilized a variety of tools to assess neurologic outcome. Only one study evaluated both IHCA and OHCA; all other studies evaluated OHCA only . With limited data from one trial regarding IHCA, further data evaluating TTM for IHCA are needed.…”

Section: Caveatsmentioning

confidence: 99%

Targeted Temperature Management in Post–Cardiac Arrest Patients

Long

Koyfman

Gottlieb

2019

Academic Emergency Medicine

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NNT color recommendationYellow (unclear if benefits) Summary heading Targeted temperature management reduces mortality and improves neurologic outcome after cardiac arrest Benefits in NNT 1 in 19 were helped (life saved) 1 in 19 were helped (better neurologic outcome) Benefits in percentages (absolute risk reduction) 5.3% lower risk of death compared to control group 5.5% lower risk of poor neurologic outcome compared to control group Harms in NNT (NNH) Not reported Harms in percentages Not reported Efficacy endpoints Death from any cause and poor neurologic outcomes

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In-Hospital Cardiac Arrest

Andersen

Holmberg

Berg

et al. 2019

JAMA

629

535

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IMPORTANCE In-hospital cardiac arrest is common and associated with a high mortality rate. Despite this, in-hospital cardiac arrest has received little attention compared with other high-risk cardiovascular conditions, such as stroke, myocardial infarction, and out-of-hospital cardiac arrest. OBSERVATIONS In-hospital cardiac arrest occurs in over 290 000 adults each year in the United States. Cohort data from the United States indicate that the mean age of patients with in-hospital cardiac arrest is 66 years, 58% are men, and the presenting rhythm is most often (81%) nonshockable (ie, asystole or pulseless electrical activity). The cause of the cardiac arrest is most often cardiac (50%-60%), followed by respiratory insufficiency (15%-40%). Efforts to prevent in-hospital cardiac arrest require both a system for identifying deteriorating patients and an appropriate interventional response (eg, rapid response teams). The key elements of treatment during cardiac arrest include chest compressions, ventilation, early defibrillation, when applicable, and immediate attention to potentially reversible causes, such as hyperkalemia or hypoxia. There is limited evidence to support more advanced treatments. Post–cardiac arrest care is focused on identification and treatment of the underlying cause, hemodynamic and respiratory support, and potentially employing neuroprotective strategies (eg, targeted temperature management). Although multiple individual factors are associated with outcomes (eg, age, initial rhythm, duration of the cardiac arrest), a multifaceted approach considering both potential for neurological recovery and ongoing multiorgan failure is warranted for prognostication and clinical decision-making in the Post–cardiac arrest period. Withdrawal of care in the absence of definite prognostic signs both during and after cardiac arrest should be avoided. Hospitals are encouraged to participate in national quality-improvement initiatives. CONCLUSIONS AND RELEVANCE An estimated 290 000 in-hospital cardiac arrests occur each year in the United States. However, there is limited evidence to support clinical decision making. An increased awareness with regard to optimizing clinical care and new research might improve outcomes.

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Randomized controlled trial of internal and external targeted temperature management methods in post- cardiac arrest patients

Cited by 45 publications

References 30 publications

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

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

Targeted Temperature Management in Post–Cardiac Arrest Patients

In-Hospital Cardiac Arrest

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