Targeted hypothermia versus targeted Normothermia after out-of-hospital cardiac arrest (TTM2): A randomized clinical trial—Rationale and design

Dankiewicz, Josef; Cronberg, Tobias; Lilja, Gisela; Jakobsen, Janus Christian; Bělohlávek, Jan; Callaway, Clifton W.; Cariou, Alain; Eastwood, Glenn M; Erlinge, David; Hovdenes, Jan; Joannidis, Michael; Kirkegaard, Hans; Kuiper, Michael; Levin, Helena; Morgan, Matt; Nichol, Alistair; Nordberg, Per; Oddo, Mauro; Pelosi, Paolo; Rylander, Christian; Saxena, Manoj; Storm, Christian; Taccone, Fabio Silvio; Ullén, Susann; Wise, Matthew Peter; Young, Paul; Friberg, Hans; Nielsen, Niklas

doi:10.1016/j.ahj.2019.06.012

Cited by 97 publications

(116 citation statements)

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“…Beide Studien werden uns in den nächsten Jahren helfen, die Akutversorgung nach phCPR und im kardiogenen Schock zu verbessern. Das Temperaturmanagement nach OHCA wird durch die TTM2-Studie untersucht, welche als primären Endpunkt das Überleben nach Monaten definiert [24]. Die deutschösterreichische S3-Leitlinie zum infarktbedingten kardiogenen Schock wurde unlängst überarbeitet und fasst alle wesentlichen diagnostischen und therapeutischen Maßnahmen zusammen [4].…”

Section: Merkeunclassified

“…Eine kontrollierte Hypothermie soll in den ersten24 Stunden nach OHCA das Ausmaß des hypoxischen Hirnschadens und des konsekutiven Hirnödems reduzieren. Nachdem zwei kleinere Studien im Jahr 2002 Vorteile durch moderate Hypothermie zeigen konnten und inzwischen invasive Kühlsysteme, die über einen zentralvenösen Katheter die Körpertemperatur auf 33-35°C absenken können, auf Intensivstationen verfügbar sind, wird dieses Verfahren bei beobachtetem Kreislaufstillstand generell empfohlen.…”

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Diagnostik und Therapie nach präklinischem Kreislaufstillstand

Ferrari¹,

Ferrari-Kühne²

2020

Dtsch Med Wochenschr

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Trotz optimaler Rettungswege und hochtechnisierter klinischer Versorgung liegt die Mortalität bei Patienten mit präklinischem Herz-Kreislauf-Stillstand oft bei über 90 %. Eine optimale Akutversorgung durch standardisierte Diagnostik und Therapie kann die Überlebenschancen auf 40 % anheben. Laufende klinische Studien dienen der Schaffung von Evidenz der aktuell empfohlenen Maßnahmen, um so die Behandlungsalgorithmen der Leitlinien in der Zukunft weiter verbessern können.

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Section: Merkeunclassified

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Diagnostik und Therapie nach präklinischem Kreislaufstillstand

Ferrari¹,

Ferrari-Kühne²

2020

Dtsch Med Wochenschr

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“…Recent guidelines have recommended targeted temperature management (TTM) as the neuroprotective intervention in resuscitation care of CA [3,5,6]. Refractory shock inducing recurrent CA or multiorgan failure (MOF) typically results in deaths within the rst 24 hours after return of spontaneous circulation (ROSC), while neurological injury causes later deaths after CA [7].…”

Section: Introductionmentioning

confidence: 99%

Thrombotic Microangiopathy Score as a New Predictor for Neurologic Outcome in Patients Undergoing Targeted Temperature Management After Out-of-hospital Cardiac Arrest

Kong

Lee

Jeon

et al. 2020

Preprint

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Abstract Background: Given the morphological characteristics of schistocytes, thrombotic microangiopathy (TMA) score can be beneficial as it can be quickly and serially measured without additional effort or costs. This study aimed to investigate whether the serial TMA scores until 48 h post admission are associated with clinical outcomes in patients undergoing targeted temperature management (TTM) after out-of-hospital cardiac arrest (OHCA). Methods:We retrospectively evaluated a cohort of 185 patients using a prospective registry. We analyzed the TMA score at admission and after 12, 24, and 48 hours. The primary outcome measures were poor neurologic outcome at discharge and 30-day mortality. Results:Increased TMA scores at all measured time points were independent predictors of poor neurologic outcomes and 30-day mortality, with the TMA score at time-12 showing the strongest correlation (OR, 3.008; 95% CI, 1.707–5.3; p=0.001 and HR, 1.517; 95% CI, 1.196–1.925; p=0.001.Specifically, TMA score ≥2 at time-12 was closely associated with increased predictability of poor neurologic outcome (OR, 6.302; 95% CI: 2.841–13.976; p<0.001) and 30-day mortality (HR, 2.656; 95% CI: 1.675–4.211; p<0.001).Conclusions: Increased TMA scores predicted the neurologic outcome and 30-day mortalityin patients undergoing TTM after OHCA. In addition to the benefit of being quickly and serially measured by using an automated hematology analyzer without additional effort or costs, this finding indicates that the TMA score may be a helpful tool for rapid risk stratification and identification of the need for intensive care in patients with ROSC after OHCA.

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“…There has not been observed increased incidence of adverse ventricular arrhythmic events during treatment with targeted hypothermia in cardiac arrest survivors [20,21]. The bene cial and harmful effects of targeted hypothermia when compared to normothermia and the optimal temperature, is still not clari ed [22,23]. EMW, electrical dispersion and mechanical dispersion are all novel parameters with clinical relevance to understand the effect of hypothermia and are not previously analysed and described.…”

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Changes in Left Ventricular Electromechanical Relations During Targeted Hypothermia

Wisløff-Aase

Kerans

Haugaa

et al. 2020

Preprint

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Background: Targeted hypothermia, as used after cardiac arrest, increases electrical and mechanical systolic duration. Differences in duration of mechanical and electrical systole are correlated to ventricular arrhythmias. The electromechanical window (EMW) becomes negative when electrical systole outlasts the mechanical systole. Prolonged electrical systole is also associated with electrical and mechanical dispersion, both predisposing for arrhythmias. The electromechanical relations during targeted hypothermia are unknown, but treatment after cardiac arrest has not demonstrated increased incidence of ventricular arrhythmic events.We wanted to explore the electromechanical relations during hypothermia at 33 °C. We hypothesized that targeted hypothermia would increase electrical and mechanical systolic duration without an increase in electromechanical negativity, nor an increase in electrical and mechanical dispersion. Methods: In a porcine model (n = 14) we registered electrocardiogram (ECG) and echocardiographic recordings during 38 °C and 33 °C, at spontaneous and atrial paced heart rate 100 beats/min. EMW was calculated by subtracting electrical systole, QT interval, from the corresponding mechanical systole, recorded from onset QRS to aortic valve closure. Electrical dispersion was measured as time from peak to end of the ECG T wave. Mechanical dispersion was calculated by strain echocardiography as standard deviation of time to peak strain. Results:Electrical systole increased during hypothermia at spontaneous heart rate (p < 0.001) and heart rate 100 beats/min (p = 0.005). Mechanical systolic duration was prolonged and outlasted electrical systole independently of heart rate (p < 0.001). EMW changed from negative to positive value (-20 ± 19 to 27 ± 34 ms, p = 0.001). The positivity was even more pronounced at heart rate 100 beats/min (-25 ± 26 to 41 ± 18 ms, p < 0.001). Electrical dispersion decreased (p = 0.027 and p = 0.003), while mechanical dispersion did not differ (p = 0.078 and p = 0.297).Conclusion: Targeted hypothermia increased electrical and mechanical systolic duration, the electromechanical window became positive, electrical dispersion was reduced and mechanical dispersion was unchanged. These alterations may have clinical importance. Further clinical studies are required to clarify whether corresponding electromechanical alterations are accommodating in humans.

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Targeted hypothermia versus targeted Normothermia after out-of-hospital cardiac arrest (TTM2): A randomized clinical trial—Rationale and design

Cited by 97 publications

References 40 publications

Diagnostik und Therapie nach präklinischem Kreislaufstillstand

Diagnostik und Therapie nach präklinischem Kreislaufstillstand

Thrombotic Microangiopathy Score as a New Predictor for Neurologic Outcome in Patients Undergoing Targeted Temperature Management After Out-of-hospital Cardiac Arrest

Changes in Left Ventricular Electromechanical Relations During Targeted Hypothermia

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