Systematic review and meta-analysis of intravascular temperature management vs. surface cooling in comatose patients resuscitated from cardiac arrest

Bartlett, Emily S.; Valenzuela, Terence D.; Idris, Ahamed H.; Deye, Nicolas; Glover, Guy; Gillies, Michael; Taccone, Fabio Silvio; Sunde, Kjetil; Flint, Alexander C.; Thiele, Holger; Arrich, Jasmin; Hemphill, Claude; Hölzer, Michael; Skrifvars, Markus B.; Pittl, Undine; Polderman, Kees H.; Ong, Marcus Eng Hock; Kim, Ki Hong; Oh, Seung Hoon; Shin, Sang Do; Kirkegaard, Hans; Nichol, Graham

doi:10.1016/j.resuscitation.2019.10.035

Cited by 34 publications

(27 citation statements)

References 55 publications

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“…Since recent review studies 6 determined that IVTM was associated with improved neurological outcomes compared to surface cooling methods among survivors resuscitated following cardiac arrest, conducting an economic evaluation to assess the costs and outcomes of IVTM method is important to help health care policymakers to identify the optimal procedure. Beside improving neurological outcome and survival rate, IVTM is associated with reduce the burden of some significant adverse event including temperature overshoot, Arrhythmia, deep venous thrombosis and shivering.…”

Section: Discussionmentioning

confidence: 99%

“…we conducted a subgroup meta-analysis on the studies which have been included in two recent review studies 6,12 to estimate the pooled probability of unfavorable neurological outcomes and mortality over the hospital admittance duration . We estimated the pooled probability of a neurological outcome in intravascular temperature management versus surface cooling methods.…”

Section: Clinical Efficacymentioning

confidence: 99%

“…We derived the risk difference in adverse events in intravascular temperature management groups versus surface cooling methods based on the result of a recent random-effect meta-analysis study 6 . The risk difference in occurrence of adverse events, along with the disutility of each event, are presented in Table 1.…”

Section: Adverse Eventsmentioning

confidence: 99%

“…Multiple methods of targeted temperature management are in clinical use to control and management of this patients 6 . Different cooling methods have specific capabilities of extracting heat, which translate to different rates of achieving the intended target temperature.…”

Section: Introductionmentioning

confidence: 99%

“…However, the IVTM provide precise temperature control during maintenance and rewarming phases of temperature management. 2 Thermogard XP ® has been used in the IVTM method to control a patient's body temperature through central venous heat exchange 6 . It can be used to induce and maintain therapeutic hypothermia in critically ill patients after cardiac arrest 8 .…”

Section: Introductionmentioning

confidence: 99%

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Cost-effectiveness analysis of Intravascular Temperature Management after cardiac arrest in England

Yaghoubi

Javanbakht²,

Mashayekhi³

et al. 2021

Preprint

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Background: Although there is recognized that Targeted Temperature Management (TTM) can improve neurological outcomes and survival in patients resuscitated from out of hospital cardiac arrest, the cost-effectiveness of multiple methods of TTM is still uncertain. Objective: This study aimed to evaluate the cost-effectiveness of Intravascular Temperature Management (IVTM) through Thermogard XP in targeted temperature management compared to surface cooling method after cardiac arrest in England. Methods: We developed a multi-state Markov model that compared intravascular temperature management through Thermogard XP and the surface cooling method through two different devices including Blanketrol III and Arctic Sun 5000, over a short-term and lifetime horizon. Model input parameters were obtained from the literature and local databases. We assumed hypothetical cohort of 1,000 patients who need TTM after cardiac arrest per year in England. The outcomes were costs (in 2019 Pound Sterling) and quality-adjusted life-years (QALYs), discounted at 3.5% annually. Deterministic and probabilistic analyses were undertaken to examine the effect of alternative assumptions and uncertainty in model parameters on the results. Results: In a simulated cohort of 1,000 patients who need TTM, the Thermogard XP resulted in direct cost savings of 2,339 Pound and 2,925 Pound (per patient) when compared with Blanketrol III and Arctic Sun 5000 respectively, and a gain of 0.98 QALYs over the patient lifetime. Total cost saving considering cohort of 1,000 patients is 2,339,479 Pound and 2,925,109 Pound when using IVTM through Thermogard XP compared with Blanketrol III and Arctic Sun 5000 respectively in life-time horizon. Results were robust against alternative assumptions, changes in values of input parameters, and alternative time horizons. Conclusion: Implementation of intravascular temperature management using Thermogard XP can lead to cost-savings and improvement in patients quality of life versus surface cooling methods. Keywords: Cost-effectiveness analysis; Thermogard XP; targeted temperature management; surface cooling method; cardiac arrest

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Section: Discussionmentioning

confidence: 99%

Section: Clinical Efficacymentioning

confidence: 99%

Section: Adverse Eventsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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