Targeted temperature management in adult cardiac arrest: Systematic review and meta- analysis

RESUSCITATION

卷:167

Review

Granfeldt, Asger¹  Holmberg, Mathias J.^2,3,4  Nolan, Jerry P.^5,6  Soar, Jasmeet⁷  Andersen, Lars W.^1,2,3,8 

[1] Aarhus Univ Hosp, Dept Anesthesiol & Intens Care Med, Aarhus, Denmark

[2] Aarhus Univ Hosp, Dept Clin Med, Res Ctr Emergency Med, Palle Juul Jensens Blvd 99,Bygning J,Plan 1, DK-8200 Aarhus N, Denmark

[3] Aarhus Univ, Aarhus, Denmark

[4] Viborg Reg Hosp, Dept Cardiol, Viborg, Denmark

[5] Univ Warwick, Warwick Med Sch, Coventry, W Midlands, England

[6] Royal United Hosp, Bath, Avon, England

[7] North Bristol NHS Trust, Southmead Hosp, Bristol, Avon, England

[8] Prehosp Emergency Med Serv, Aarhus, Centra Denmark, Denmark

关键词: Cardiac arrest;    Targeted temperature management;    Hypothermia;    Cooling;    Systematic review;   

DOI  :  10.1016/j.resuscitation.2021.08.040

来源: Elsevier

【 摘 要 】

Aim: To perform a systematic review and meta-analysis on targeted temperature management in adult cardiac arrest patients. Methods: PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched on June 17, 2021 for clinical trials. The population included adult patients with cardiac arrest. The review included all aspects of targeted temperature management including timing, temperature, duration, method of induction and maintenance, and rewarming. Two investigators reviewed trials for relevance, extracted data, and assessed risk of bias. Data were pooled using random-effects models. Certainty of evidence was evaluated using GRADE. Results: The systematic search identified 32 trials. Risk of bias was assessed as intermediate for most of the outcomes. For targeted temperature management with a target of 32-34 degrees C vs. normothermia (which often required active cooling), 9 trials were identified, with six trials included in meta analyses. Targeted temperature management with a target of 32-34 degrees C did not result in an improvement in survival (risk ratio: 1.08 [95%CI: 0.89, 1.30]) or favorable neurologic outcome (risk ratio: 1.21 [95%CI: 0.91, 1.61]) at 90 to 180 days after the cardiac arrest (low certainty of evidence). Three trials assessed different hypothermic temperature targets and found no difference in outcomes (low certainty of evidence). Ten trials were identified comparing prehospital cooling vs. no prehospital cooling with no improvement in survival (risk ratio: 1.01 [95%CI: 0.92, 1.11]) or favorable neurologic outcome (risk ratio: 1.00 [95%CI: 0.90, 1.11]) at hospital discharge (moderate certainty of evidence). Conclusions: Among adult patients with cardiac arrest, the use of targeted temperature management at 32-34 degrees C, when compared to normothermia, did not result in improved outcomes in this meta-analysis. There was no effect of initiating targeted temperature management prior to hospital arrival. These findings warrant an update of international cardiac arrest guidelines.

【 授权许可】

Free