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Hypothermia versus normothermia in patients with cardiac arrest and shockable rhythm : a secondary analysis of the TTM-2 study

Taccone, Fabio Silvio ; Cariou, Alain ; Zorzi, Stefano ; Friberg, Hans LU ; Jakobsen, Janus C. ; Nordberg, Per ; Robba, Chiara ; Belohlavek, Jan ; Hovdenes, Jan and Haenggi, Matthias , et al. (2024) In Critical Care 28(1).
Abstract

Background: The aim of this study was to assess whether hypothermia increased survival and improved functional outcome when compared with normothermia in out-of-hospital cardiac arrest (OHCA) patients with similar characteristics than in previous randomized studies showing benefits for hypothermia. Methods: Post hoc analysis of a pragmatic, multicenter, randomized clinical trial (TTM-2, NCT02908308). In this analysis, the subset of patients included in the trial who had similar characteristics to patients included in one previous randomized trial and randomized to hypothermia at 33 °C or normothermia (i.e. target < 37.8 °C) were considered. The primary outcome was survival at 6 months; secondary outcomes included favorable functional... (More)

Background: The aim of this study was to assess whether hypothermia increased survival and improved functional outcome when compared with normothermia in out-of-hospital cardiac arrest (OHCA) patients with similar characteristics than in previous randomized studies showing benefits for hypothermia. Methods: Post hoc analysis of a pragmatic, multicenter, randomized clinical trial (TTM-2, NCT02908308). In this analysis, the subset of patients included in the trial who had similar characteristics to patients included in one previous randomized trial and randomized to hypothermia at 33 °C or normothermia (i.e. target < 37.8 °C) were considered. The primary outcome was survival at 6 months; secondary outcomes included favorable functional outcome at 6 months, defined as a modified Rankin scale of 0–3. Time-to-death and the occurrence of adverse events were also reported. Results: From a total of 1891 included in the TTM-2 study, 600 (31.7%) were included in the analysis, 294 in the hypothermia and 306 in the normothermia group. At 6 months, 207 of the 294 patients (70.4%) in the hypothermia group and 220 of the 306 patients (71.8%) in the normothermia group had survived (relative risk with hypothermia, 0.96; 95% confidence interval [CI], 0.81 to 1.15; P = 0.71). Also, 198 of the 294 (67.3%) in the hypothermia group and 202 of the 306 (66.0%) in the normothermia group had a favorable functional outcome (relative risk with hypothermia, 1.03; 95% CI, 0.87 to 1.23; P = 0.79). There was a significant increase in the occurrence of arrythmias in the hypothermia group (62/294, 21.2%) when compared to the normothermia group (43/306, 14.1%—OR 1.49, 95% CI 1.05–2.14; p = 0.026). Conclusions: In this study, hypothermia at 33˚C did not improve survival or functional outcome in a subset of patients with similar cardiac arrest characteristics to patients in whom benefit from hypothermia was shown in prior studies.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Cardiac arrest, Hypothermia, Outcome, Shockable rhythm
in
Critical Care
volume
28
issue
1
article number
335
publisher
BioMed Central (BMC)
external identifiers
  • pmid:39407230
  • scopus:85206470958
ISSN
1364-8535
DOI
10.1186/s13054-024-05119-3
language
English
LU publication?
yes
id
e3f42f0e-f48d-4d9c-b400-6d07de2f70d5
date added to LUP
2024-11-27 14:31:49
date last changed
2025-05-15 05:06:44
@article{e3f42f0e-f48d-4d9c-b400-6d07de2f70d5,
  abstract     = {{<p>Background: The aim of this study was to assess whether hypothermia increased survival and improved functional outcome when compared with normothermia in out-of-hospital cardiac arrest (OHCA) patients with similar characteristics than in previous randomized studies showing benefits for hypothermia. Methods: Post hoc analysis of a pragmatic, multicenter, randomized clinical trial (TTM-2, NCT02908308). In this analysis, the subset of patients included in the trial who had similar characteristics to patients included in one previous randomized trial and randomized to hypothermia at 33 °C or normothermia (i.e. target &lt; 37.8 °C) were considered. The primary outcome was survival at 6 months; secondary outcomes included favorable functional outcome at 6 months, defined as a modified Rankin scale of 0–3. Time-to-death and the occurrence of adverse events were also reported. Results: From a total of 1891 included in the TTM-2 study, 600 (31.7%) were included in the analysis, 294 in the hypothermia and 306 in the normothermia group. At 6 months, 207 of the 294 patients (70.4%) in the hypothermia group and 220 of the 306 patients (71.8%) in the normothermia group had survived (relative risk with hypothermia, 0.96; 95% confidence interval [CI], 0.81 to 1.15; P = 0.71). Also, 198 of the 294 (67.3%) in the hypothermia group and 202 of the 306 (66.0%) in the normothermia group had a favorable functional outcome (relative risk with hypothermia, 1.03; 95% CI, 0.87 to 1.23; P = 0.79). There was a significant increase in the occurrence of arrythmias in the hypothermia group (62/294, 21.2%) when compared to the normothermia group (43/306, 14.1%—OR 1.49, 95% CI 1.05–2.14; p = 0.026). Conclusions: In this study, hypothermia at 33˚C did not improve survival or functional outcome in a subset of patients with similar cardiac arrest characteristics to patients in whom benefit from hypothermia was shown in prior studies.</p>}},
  author       = {{Taccone, Fabio Silvio and Cariou, Alain and Zorzi, Stefano and Friberg, Hans and Jakobsen, Janus C. and Nordberg, Per and Robba, Chiara and Belohlavek, Jan and Hovdenes, Jan and Haenggi, Matthias and Åneman, Anders and Grejs, Anders and Keeble, Thomas R. and Annoni, Filippo and Young, Paul J. and Wise, Matt P. and Cronberg, Tobias and Lilja, Gisela and Nielsen, Niklas and Dankiewicz, Josef}},
  issn         = {{1364-8535}},
  keywords     = {{Cardiac arrest; Hypothermia; Outcome; Shockable rhythm}},
  language     = {{eng}},
  number       = {{1}},
  publisher    = {{BioMed Central (BMC)}},
  series       = {{Critical Care}},
  title        = {{Hypothermia versus normothermia in patients with cardiac arrest and shockable rhythm : a secondary analysis of the TTM-2 study}},
  url          = {{http://dx.doi.org/10.1186/s13054-024-05119-3}},
  doi          = {{10.1186/s13054-024-05119-3}},
  volume       = {{28}},
  year         = {{2024}},
}