Meta-analysis depicting the outcomes of hypothermia versus normothermia post cardiac arrest
Abstract Background The current American Heart Association (AHA) 2020 guidelines recommend targeted temperature monitoring (TTM) for cardiac arrest patients. However, more recently published trials intrigued us to review the therapeutic benefit of TTM. Objective To assess the usefulness of recommend...
Saved in:
Published in | European heart journal Vol. 44; no. Supplement_2 |
---|---|
Main Authors | , , , , , |
Format | Journal Article |
Language | English |
Published |
09.11.2023
|
Online Access | Get full text |
Cover
Loading…
Abstract | Abstract
Background
The current American Heart Association (AHA) 2020 guidelines recommend targeted temperature monitoring (TTM) for cardiac arrest patients. However, more recently published trials intrigued us to review the therapeutic benefit of TTM.
Objective
To assess the usefulness of recommended TTM temperature (< 36° C), we performed this updated meta-analysis of randomized controlled trials (RCTs), including the latest Targeted Hypothermia Versus Targeted Normothermia After Out-of-hospital Cardiac Arrest-2 (TTM2) trial and trial conducted by Wolfrum S., comparing neurological and mortality outcomes in targeted hypothermia (TH) (< 36° C) with normothermia group (> 36° C).
Methods
We searched Cochrane, MEDLINE, and EMBASE from inception to December 2022. Only trials with patients randomized for TTM and reported neurological and mortality outcomes were included. Non-randomized design, retrospective cohorts, and non-English abstracts were excluded. The data was extracted using full text for all RCTs except two where abstract and previous meta-analysis was used. Statistical analysis was performed using Cochrane Review Manager using the random effects model and calculated pooled risk ratios of outcomes using the Mantel-Haenszel method.
Results
A total of 12 RCTs and 4,262 patients were included in the review (Table 1). Almost 80% weight was carried by four trials (Lascarrou JB, Dankiewicz J, Nielsen N, and Wolfrum S). The neurological outcomes were mainly measured using the cerebral performance category (CPC) scoring in the RCTs. Patients had significantly improved neurological outcomes [Risk Ratio (RR) 0.90, 95% Confidence Interval (CI): 0.83, 0.98, p = 0.02, I² = 61%] in the TH group (Figure 1). However, no significant difference in mortality was observed [RR 0.97, 95% CI: 0.90, 1.06, p = 0.55, I² = 38%]. In patients with an initial shockable rhythm, no significant difference in the neurological [RR 0.82 (95% CI: 0.67, 1.00), p = 0.05, I² = 82] and mortality outcomes [RR 0.82, 95% CI: 0.57,1.18, p=0.29, I²=94%] was seen between the two groups.
Conclusion
Our meta-analysis indicates a therapeutic benefit in neurological outcomes of patients undergoing TH post-cardiac arrest. Our findings align with the current AHA guidelines and demonstrate the utility of TH irrespective of the initial rhythm.Table 1Figure 1 |
---|---|
AbstractList | Abstract
Background
The current American Heart Association (AHA) 2020 guidelines recommend targeted temperature monitoring (TTM) for cardiac arrest patients. However, more recently published trials intrigued us to review the therapeutic benefit of TTM.
Objective
To assess the usefulness of recommended TTM temperature (< 36° C), we performed this updated meta-analysis of randomized controlled trials (RCTs), including the latest Targeted Hypothermia Versus Targeted Normothermia After Out-of-hospital Cardiac Arrest-2 (TTM2) trial and trial conducted by Wolfrum S., comparing neurological and mortality outcomes in targeted hypothermia (TH) (< 36° C) with normothermia group (> 36° C).
Methods
We searched Cochrane, MEDLINE, and EMBASE from inception to December 2022. Only trials with patients randomized for TTM and reported neurological and mortality outcomes were included. Non-randomized design, retrospective cohorts, and non-English abstracts were excluded. The data was extracted using full text for all RCTs except two where abstract and previous meta-analysis was used. Statistical analysis was performed using Cochrane Review Manager using the random effects model and calculated pooled risk ratios of outcomes using the Mantel-Haenszel method.
Results
A total of 12 RCTs and 4,262 patients were included in the review (Table 1). Almost 80% weight was carried by four trials (Lascarrou JB, Dankiewicz J, Nielsen N, and Wolfrum S). The neurological outcomes were mainly measured using the cerebral performance category (CPC) scoring in the RCTs. Patients had significantly improved neurological outcomes [Risk Ratio (RR) 0.90, 95% Confidence Interval (CI): 0.83, 0.98, p = 0.02, I² = 61%] in the TH group (Figure 1). However, no significant difference in mortality was observed [RR 0.97, 95% CI: 0.90, 1.06, p = 0.55, I² = 38%]. In patients with an initial shockable rhythm, no significant difference in the neurological [RR 0.82 (95% CI: 0.67, 1.00), p = 0.05, I² = 82] and mortality outcomes [RR 0.82, 95% CI: 0.57,1.18, p=0.29, I²=94%] was seen between the two groups.
Conclusion
Our meta-analysis indicates a therapeutic benefit in neurological outcomes of patients undergoing TH post-cardiac arrest. Our findings align with the current AHA guidelines and demonstrate the utility of TH irrespective of the initial rhythm.Table 1Figure 1 |
Author | Taha, A Duhan, S Keisham, B Singh, S Rout, A Sandhyavenu, H |
Author_xml | – sequence: 1 givenname: S surname: Duhan fullname: Duhan, S – sequence: 2 givenname: B surname: Keisham fullname: Keisham, B – sequence: 3 givenname: S surname: Singh fullname: Singh, S – sequence: 4 givenname: A surname: Taha fullname: Taha, A – sequence: 5 givenname: H surname: Sandhyavenu fullname: Sandhyavenu, H – sequence: 6 givenname: A surname: Rout fullname: Rout, A |
BookMark | eNo90M1KAzEYheEgFWyrtyC5gWnzP8lSin9QcaMguBjS5IszpTMZklTo3Wtp6erAuziLZ4YmQxwAoXtKFpQYvoR9asGmsl1Ca72SckEVEVdoSiVjlVFCTtCUUCMrpfTXDZrlvCWEaEXVFH2_QbGVHezukLuMPYydK93wg0sLOO6Liz1kHANuD2P8b6nvLP6FlPcZDzH1lzbGXLCzyXfWYZsS5HKLroPdZbg77xx9Pj1-rF6q9fvz6-phXTnKa1EFyzeEBE8o1F5IRVktLbOgTAgbCsxpEiQXyginBQgPutaGGc-1rgUwzedInX5dijknCM2Yut6mQ0NJcyRqLkTNmag5EvE_T01ifg |
ContentType | Journal Article |
DBID | AAYXX CITATION |
DOI | 10.1093/eurheartj/ehad655.1604 |
DatabaseName | CrossRef |
DatabaseTitle | CrossRef |
DatabaseTitleList | CrossRef |
DeliveryMethod | fulltext_linktorsrc |
Discipline | Medicine |
EISSN | 1522-9645 |
ExternalDocumentID | 10_1093_eurheartj_ehad655_1604 |
GroupedDBID | --- -E4 .2P .I3 .XZ .ZR 08P 0R~ 18M 1TH 2WC 4.4 482 48X 53G 5GY 5RE 5VS 5WA 5WD 70D AABZA AACZT AAJKP AAMVS AAOGV AAPNW AAPQZ AAPXW AARHZ AASNB AAUAY AAVAP AAYXX ABEUO ABIXL ABKDP ABNHQ ABNKS ABOCM ABPTD ABQLI ABQNK ABWST ABXVV ABZBJ ACGFO ACGFS ACPRK ACUFI ACUTJ ACUTO ACYHN ADBBV ADEYI ADEZT ADGZP ADHKW ADHZD ADIPN ADJQC ADOCK ADQBN ADRIX ADRTK ADVEK ADYVW ADZXQ AEGPL AEGXH AEJOX AEKSI AEMDU AENEX AENZO AEPUE AETBJ AEWNT AFFZL AFIYH AFOFC AFXAL AFXEN AGINJ AGKEF AGQXC AGSYK AGUTN AHMBA AHXPO AIAGR AIJHB AJEEA ALMA_UNASSIGNED_HOLDINGS ALUQC APIBT APWMN ATGXG AXUDD BAWUL BAYMD BCGUY BCRHZ BEYMZ BHONS BTRTY BVRKM C45 CDBKE CITATION CS3 CZ4 DAKXR DILTD D~K E3Z EBS EE~ ENERS F5P F9B FECEO FLUFQ FOEOM FOTVD FQBLK GAUVT GJXCC H5~ HAR HW0 HZ~ IOX J21 KAQDR KOP KQ8 KSI KSN L7B M-Z M41 M49 MHKGH N9A NGC NOMLY NOYVH NU- O9- OAUYM OAWHX OB3 OCZFY ODMLO OGROG OJQWA OJZSN OK1 OPAEJ OVD OWPYF P2P PAFKI PEELM PQQKQ Q1. Q5Y R44 RD5 ROL ROX RUSNO RW1 RXO SEL TCURE TEORI TJX WOQ X7H YAYTL YKOAZ YXANX ZKX ~91 |
ID | FETCH-LOGICAL-c1374-fa3b00fd01e7d4561275a2ae69ffb1e2c80f534694c84e4de878929d38874e283 |
ISSN | 0195-668X |
IngestDate | Thu Sep 12 17:22:08 EDT 2024 |
IsDoiOpenAccess | false |
IsOpenAccess | true |
IsPeerReviewed | true |
IsScholarly | true |
Issue | Supplement_2 |
Language | English |
LinkModel | OpenURL |
MergedId | FETCHMERGED-LOGICAL-c1374-fa3b00fd01e7d4561275a2ae69ffb1e2c80f534694c84e4de878929d38874e283 |
OpenAccessLink | https://academic.oup.com/eurheartj/article-pdf/44/Supplement_2/ehad655.1604/53606676/ehad655.1604.pdf |
ParticipantIDs | crossref_primary_10_1093_eurheartj_ehad655_1604 |
PublicationCentury | 2000 |
PublicationDate | 2023-11-09 |
PublicationDateYYYYMMDD | 2023-11-09 |
PublicationDate_xml | – month: 11 year: 2023 text: 2023-11-09 day: 09 |
PublicationDecade | 2020 |
PublicationTitle | European heart journal |
PublicationYear | 2023 |
SSID | ssj0008616 |
Score | 2.483534 |
Snippet | Abstract
Background
The current American Heart Association (AHA) 2020 guidelines recommend targeted temperature monitoring (TTM) for cardiac arrest patients.... |
SourceID | crossref |
SourceType | Aggregation Database |
Title | Meta-analysis depicting the outcomes of hypothermia versus normothermia post cardiac arrest |
Volume | 44 |
hasFullText | 1 |
inHoldings | 1 |
isFullTextHit | |
isPrint | |
link | http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwnV3Na9swFBdpB6WX0q4rbdcOHXYLWhxLsq3jKC1hIYOxBAI9GNmScQtNTOcctr9-Tx92nBBK24ONEfaLnPdD7-en94HQVxloHucZI0xnkoA9ZkQkISWCakozKnJqS-ZPfkajGfsx5_Ner-pELa3q7Fv-b2deyXu0CmOgV5Ml-wbNtkJhAK5Bv3AGDcP5VTqe6FoS2ZQVUboy-R0-_Wm5quEnXUnZ8m9lE62eHmTfhGGYoqzAVduxavmnNjWqASt5X9p2HTs99qb7dd3vTs1S4HLLiTrWpqWzBVq7ofMb5lVu3DWVpVw7U73jAfRnnKmi64sUnESR7QwMpsSvn_BtKyJXIbJZYF2BRw8k26zUej7TcOcS7spb6dWzfadHc11KFXFuHGFsbbaarfota9bGGLrddZq2klIvJzVy9tCHMBbcBIGOf63ryyeRbZbbvlqTUy7ooJUz6M6nQ2c6vGR6jI78BwX-7tBxgnp68REdTHzIxCm63wAJbkGCQfm4AQleFrgDEuxAgrsgwQYk2IMEO5B8QrO72-nNiPiOGiQf0piRQlJYZgsVDHWsDHUOYy5DqSNRFNlQh3kSFJyySLA8YZopncQJ8GdFwRQxDUz0DO0vlgt9jnAog1wVCTzBAiA4wHKEgoPHwCELpdgFGjR_TFq5winpyyq5fPMTn9HhGphXaL9-Xulr4Ih19sWq9T_Hu23Q |
link.rule.ids | 315,786,790,27955,27956 |
linkProvider | Colorado Alliance of Research Libraries |
openUrl | ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Meta-analysis+depicting+the+outcomes+of+hypothermia+versus+normothermia+post+cardiac+arrest&rft.jtitle=European+heart+journal&rft.au=Duhan%2C+S&rft.au=Keisham%2C+B&rft.au=Singh%2C+S&rft.au=Taha%2C+A&rft.date=2023-11-09&rft.issn=0195-668X&rft.eissn=1522-9645&rft.volume=44&rft.issue=Supplement_2&rft_id=info:doi/10.1093%2Feurheartj%2Fehad655.1604&rft.externalDBID=n%2Fa&rft.externalDocID=10_1093_eurheartj_ehad655_1604 |
thumbnail_l | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/lc.gif&issn=0195-668X&client=summon |
thumbnail_m | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/mc.gif&issn=0195-668X&client=summon |
thumbnail_s | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/sc.gif&issn=0195-668X&client=summon |