TY - JOUR
T1 - Targeted temperature management following out-of-hospital cardiac arrest
T2 - a systematic review and network meta-analysis of temperature targets
AU - Fernando, Shannon M.
AU - Di Santo, Pietro
AU - Sadeghirad, Behnam
AU - Lascarrou, Jean Baptiste
AU - Rochwerg, Bram
AU - Mathew, Rebecca
AU - Sekhon, Mypinder S.
AU - Munshi, Laveena
AU - Fan, Eddy
AU - Brodie, Daniel
AU - Rowan, Kathryn M.
AU - Hough, Catherine L.
AU - McLeod, Shelley L.
AU - Vaillancourt, Christian
AU - Cheskes, Sheldon
AU - Ferguson, Niall D.
AU - Scales, Damon C.
AU - Sandroni, Claudio
AU - Nolan, Jerry P.
AU - Hibbert, Benjamin
N1 - Funding Information:
Dr. Shannon M. Fernando has no conflicts to report. Dr. Pietro Di Santo has no conflicts to report. Dr. Behnam Sadeghirad reports receiving funding from PIPRA AG, outside of the submitted work. Dr. Jean-Baptiste Lascarrou reports receiving lecture fees from Zoll Medical Inc. and BD. Dr. Bram Rochwerg has no conflicts to report. Dr. Rebecca Mathew has no conflicts to report. Dr. Mypinder S. Sekhon has no conflicts to report. Dr. Laveena Munshi has no conflicts to report. Dr. Eddy Fan reports receiving personal fees from ALung Technologies, Baxter, Boehringer-Ingelheim, Fresenius Medical Care, MC3 Cardiopulmonary, and Vasomune, outside of the submitted work. Dr. Daniel Brodie reports receiving research support from ALung Technologies, outside of the submitted work, and was previously on their medical advisory board. He has been on the medical advisory boards for Baxter, Abiomed, Xenios, and Hemovent. Dr. Kathryn M. Rowan has no conflicts to report. Dr. Catherine L. Hough has no conflicts to report. Dr. Shelley L. McLeod has no conflicts to report. Dr. Christian Vaillancourt has no conflicts to report. Dr. Sheldon Cheskes reports receiving research support from Zoll Medical Inc., outside of the submitted work. Dr. Niall D. Ferguson reports consulting for Baxter and Xenios, outside of the submitted work. He is a member of the Editorial Board of Intensive Care Medicine. Dr. Damon C. Scales has no conflicts to report. Dr. Claudio Sandroni is a member of the Editorial Board of Intensive Care Medicine. Dr. Jerry P. Nolan is Editor-in-Chief of Resuscitation. Dr. Benjamin Hibbert reports receiving research support from Abbott, Edwards Lifesciences, Boston Scientific, and Bayer, outside of the submitted work.
Publisher Copyright:
© 2021, Springer-Verlag GmbH Germany, part of Springer Nature.
PY - 2021/10
Y1 - 2021/10
N2 - Purpose: Targeted temperature management (TTM) may improve survival and functional outcome in comatose survivors of out-of-hospital cardiac arrest (OHCA), though the optimal target temperature remains unknown. We conducted a systematic review and network meta-analysis to investigate the efficacy and safety of deep hypothermia (31–32 °C), moderate hypothermia (33–34 °C), mild hypothermia (35–36 °C), and normothermia (37–37.8 °C) during TTM. Methods: We searched six databases from inception to June 2021 for randomized controlled trials (RCTs) evaluating TTM in comatose OHCA survivors. Two reviewers performed screening, full text review, and extraction independently. The primary outcome of interest was survival with good functional outcome. We used GRADE to rate our certainty in estimates. Results: We included 10 RCTs (4218 patients). Compared with normothermia, deep hypothermia (odds ratio [OR] 1.30, 95% confidence interval [CI] 0.73–2.30), moderate hypothermia (OR 1.34, 95% CI 0.92–1.94) and mild hypothermia (OR 1.44, 95% CI 0.74–2.80) may have no effect on survival with good functional outcome (all low certainty). Deep hypothermia may not improve survival with good functional outcome, as compared to moderate hypothermia (OR 0.97, 95% CI 0.61–1.54, low certainty). Moderate hypothermia (OR 1.23, 95% CI 0.86–1.77) and deep hypothermia (OR 1.27, 95% CI 0.70–2.32) may have no effect on survival, as compared to normothermia. Finally, incidence of arrhythmia was higher with moderate hypothermia (OR 1.45, 95% CI 1.08–1.94) and deep hypothermia (OR 3.58, 95% CI 1.77–7.26), compared to normothermia (both high certainty). Conclusions: Mild, moderate, or deep hypothermia may not improve survival or functional outcome after OHCA, as compared to normothermia. Moderate and deep hypothermia were associated with higher incidence of arrhythmia. Routine use of moderate or deep hypothermia in comatose survivors of OHCA may potentially be associated with more harm than benefit.
AB - Purpose: Targeted temperature management (TTM) may improve survival and functional outcome in comatose survivors of out-of-hospital cardiac arrest (OHCA), though the optimal target temperature remains unknown. We conducted a systematic review and network meta-analysis to investigate the efficacy and safety of deep hypothermia (31–32 °C), moderate hypothermia (33–34 °C), mild hypothermia (35–36 °C), and normothermia (37–37.8 °C) during TTM. Methods: We searched six databases from inception to June 2021 for randomized controlled trials (RCTs) evaluating TTM in comatose OHCA survivors. Two reviewers performed screening, full text review, and extraction independently. The primary outcome of interest was survival with good functional outcome. We used GRADE to rate our certainty in estimates. Results: We included 10 RCTs (4218 patients). Compared with normothermia, deep hypothermia (odds ratio [OR] 1.30, 95% confidence interval [CI] 0.73–2.30), moderate hypothermia (OR 1.34, 95% CI 0.92–1.94) and mild hypothermia (OR 1.44, 95% CI 0.74–2.80) may have no effect on survival with good functional outcome (all low certainty). Deep hypothermia may not improve survival with good functional outcome, as compared to moderate hypothermia (OR 0.97, 95% CI 0.61–1.54, low certainty). Moderate hypothermia (OR 1.23, 95% CI 0.86–1.77) and deep hypothermia (OR 1.27, 95% CI 0.70–2.32) may have no effect on survival, as compared to normothermia. Finally, incidence of arrhythmia was higher with moderate hypothermia (OR 1.45, 95% CI 1.08–1.94) and deep hypothermia (OR 3.58, 95% CI 1.77–7.26), compared to normothermia (both high certainty). Conclusions: Mild, moderate, or deep hypothermia may not improve survival or functional outcome after OHCA, as compared to normothermia. Moderate and deep hypothermia were associated with higher incidence of arrhythmia. Routine use of moderate or deep hypothermia in comatose survivors of OHCA may potentially be associated with more harm than benefit.
KW - Critical care medicine
KW - Emergency medicine
KW - Hypoxic
KW - Ischemic brain injury
KW - Out-of-hospital cardiac arrest
KW - Targeted temperature management
UR - http://www.scopus.com/inward/record.url?scp=85112440171&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85112440171&partnerID=8YFLogxK
U2 - 10.1007/s00134-021-06505-z
DO - 10.1007/s00134-021-06505-z
M3 - Review article
C2 - 34389870
AN - SCOPUS:85112440171
SN - 0342-4642
VL - 47
SP - 1078
EP - 1088
JO - Intensive Care Medicine
JF - Intensive Care Medicine
IS - 10
ER -