Hypothermia versus normothermia after out-of-hospital cardiac arrest: A systematic review and meta-analysis of randomized controlled trials.
Ann Med Surg (Lond)
; 74: 103327, 2022 Feb.
Article
em En
| MEDLINE
| ID: mdl-35145684
ABSTRACT
BACKGROUND:
The current guidelines recommend targeted temperature management (TTM) as part of the post-resuscitation care for comatose patients following out-of-hospital cardiac arrest. These recommendations are based on the weak evidence of benefit seen in the early clinical trials. Recent large multicentered trials have failed to show a meaningful clinical benefit of hypothermia, unlike the earlier studies. Thus, to fully appraise the available data, we sought to perform this systematic review and meta-analysis of randomized controlled trials.METHODS:
We searched four databases for randomized controlled trials comparing therapeutic hypothermia (32-34 °C) with normothermia (≥36 °C with control of fever) in adult patients resuscitated after out-of-hospital cardiac arrest. Independent reviewers did the title and abstract screening, full-text screening, and extraction. The primary outcome was mortality six months after cardiac arrest, and secondary outcomes were neurological outcomes and adverse effects. RELEVANCE FOR PATIENTS Six randomized controlled trials were included in this review. There was no significant difference between the hypothermia and normothermia groups in mortality till 6 months follow up after out-of-hospital cardiac arrest (OR 0.88, 95% CI 0.67-1.16; n = 3243; I2 = 51%), or favorable neurological outcome (OR 1.31, 95% CI 0.93-1.84; n = 3091; I2 = 68%). Rates of arrhythmias were notably higher in the hypothermia group than the normothermia group (OR 1.43, 95% CI 1.20-1.71; n = 3029; I2 = 4%). However, odds for development of pneumonia showed no significant differences across two groups (OR 1.13, 95% CI 0.98-1.31; n = 3056; I2 = 22%). Therefore, targeted hypothermia with a target temperature of 32-34 °C does not provide mortality benefit or better neurological outcome in patients resuscitated after the out-of-hospital cardiac arrest when compared with normothermia.
AHA, American Heart Association; CI, Confidence interval; ESC, European resuscitation council; IHCA, In-hospital cardiac arrest; Induced Hypothermia; OHCA, Out-of-hospital cardiac arrest; OR, Odds ratio; Out-of-hospital cardiac arrest; PRISMA, Preferred Reporting Items for Systematic Review and Meta-Analysis; RCTs, Randomized controlled trials; ROSC, Return of spontaneous circulation; TH, Therapeutic hypothermia; TTM, Targeted temperature management; Temperature
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Tipo de estudo:
Clinical_trials
/
Guideline
/
Systematic_reviews
Idioma:
En
Revista:
Ann Med Surg (Lond)
Ano de publicação:
2022
Tipo de documento:
Article