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Intravascular vs. surface cooling in out-of-hospital cardiac arrest patients receiving hypothermia after hospital arrival : a post hoc analysis of the TTM2 trial

Awad, Akil ; Jonsson, Martin ; Holgersson, Johan LU ; Jakobsen, Janus Christian ; Hollenberg, Jacob ; Thomas, Matthew ; Garcia, Pedro D.Wendel ; Ringh, Mattias ; Grejs, Anders M. and Keeble, Thomas R. , et al. (2025) In Intensive Care Medicine 51(4). p.721-730
Abstract

Purpose: To compare the performance of targeted temperature management (TTM) at 33 °C using intravascular (IC) vs. surface-cooling (SFC) devices after out-of-hospital cardiac arrest (OHCA). Methods: A post hoc analysis including OHCA patients randomized to hypothermia in the TTM2-trial (NCT02908308) comparing hypothermia with normothermia. The main outcome was cooling performance, defined as the proportion of patients reaching target temperature < 33.5 °C within 4 h, time outside temperature ranges during maintenance, rewarming rate and post-TTM fever. Exploratory outcomes included survival and good functional outcome, defined as modified Rankin Scale (mRS) scores of 0–3 at 6 months, analyzed using Inverse Probability Treatment... (More)

Purpose: To compare the performance of targeted temperature management (TTM) at 33 °C using intravascular (IC) vs. surface-cooling (SFC) devices after out-of-hospital cardiac arrest (OHCA). Methods: A post hoc analysis including OHCA patients randomized to hypothermia in the TTM2-trial (NCT02908308) comparing hypothermia with normothermia. The main outcome was cooling performance, defined as the proportion of patients reaching target temperature < 33.5 °C within 4 h, time outside temperature ranges during maintenance, rewarming rate and post-TTM fever. Exploratory outcomes included survival and good functional outcome, defined as modified Rankin Scale (mRS) scores of 0–3 at 6 months, analyzed using Inverse Probability Treatment Weighting (IPTW). Results: Among 930 patients randomized to hypothermia, 876 were treated with a cooling device and included in this study. Of those, 27.3% received IC devices, while 72.7% received SFC devices. The proportion reaching target temperature within 4 h was higher with IC (IC: 69.6% vs. SFC: 49.2%; p < 0.001). Temperature outside ranges during the cooling period and post-TTM fever were lower with IC compared to SFC (17.2% vs. 39.6%; p < 0.001 and 0% vs. 6.3%; p < 0.001, respectively). In the exploratory IPTW analysis, 6-month survival rates were 55.2% in the IC group and 50.2% in the SFC group (OR 1.22, 95% CI 0.89–1.68) and survival with good functional outcome at 6 months was 51.1% patients in the IC group and 44.9% in the SFC (OR 1.28, 95% CI 0.93–1.77). Conclusions: Among OHCA patients randomized to hypothermia in the TTM2 study, intravascular cooling, compared with surface cooling, was associated with better cooling performance.

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organization
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type
Contribution to journal
publication status
published
subject
keywords
Hypothermia, Intravascular cooling, Out-of-hospital cardiac arrest, Surface cooling
in
Intensive Care Medicine
volume
51
issue
4
pages
10 pages
publisher
Springer Science and Business Media B.V.
external identifiers
  • scopus:105004217419
  • pmid:40293464
ISSN
0342-4642
DOI
10.1007/s00134-025-07883-4
language
English
LU publication?
yes
id
19bd4f13-765d-4393-ba78-c78a35f2a27d
date added to LUP
2025-08-12 12:02:45
date last changed
2025-08-12 12:03:21
@article{19bd4f13-765d-4393-ba78-c78a35f2a27d,
  abstract     = {{<p>Purpose: To compare the performance of targeted temperature management (TTM) at 33 °C using intravascular (IC) vs. surface-cooling (SFC) devices after out-of-hospital cardiac arrest (OHCA). Methods: A post hoc analysis including OHCA patients randomized to hypothermia in the TTM2-trial (NCT02908308) comparing hypothermia with normothermia. The main outcome was cooling performance, defined as the proportion of patients reaching target temperature &lt; 33.5 °C within 4 h, time outside temperature ranges during maintenance, rewarming rate and post-TTM fever. Exploratory outcomes included survival and good functional outcome, defined as modified Rankin Scale (mRS) scores of 0–3 at 6 months, analyzed using Inverse Probability Treatment Weighting (IPTW). Results: Among 930 patients randomized to hypothermia, 876 were treated with a cooling device and included in this study. Of those, 27.3% received IC devices, while 72.7% received SFC devices. The proportion reaching target temperature within 4 h was higher with IC (IC: 69.6% vs. SFC: 49.2%; p &lt; 0.001). Temperature outside ranges during the cooling period and post-TTM fever were lower with IC compared to SFC (17.2% vs. 39.6%; p &lt; 0.001 and 0% vs. 6.3%; p &lt; 0.001, respectively). In the exploratory IPTW analysis, 6-month survival rates were 55.2% in the IC group and 50.2% in the SFC group (OR 1.22, 95% CI 0.89–1.68) and survival with good functional outcome at 6 months was 51.1% patients in the IC group and 44.9% in the SFC (OR 1.28, 95% CI 0.93–1.77). Conclusions: Among OHCA patients randomized to hypothermia in the TTM2 study, intravascular cooling, compared with surface cooling, was associated with better cooling performance.</p>}},
  author       = {{Awad, Akil and Jonsson, Martin and Holgersson, Johan and Jakobsen, Janus Christian and Hollenberg, Jacob and Thomas, Matthew and Garcia, Pedro D.Wendel and Ringh, Mattias and Grejs, Anders M. and Keeble, Thomas R. and Bělohlávek, Jan and Cariou, Alain and Annoni, Filippo and Lilja, Gisela and Taccone, Fabio Silvio and Rylander, Christian and Nielsen, Niklas and Dankiewicz, Josef and Nordberg, Per}},
  issn         = {{0342-4642}},
  keywords     = {{Hypothermia; Intravascular cooling; Out-of-hospital cardiac arrest; Surface cooling}},
  language     = {{eng}},
  number       = {{4}},
  pages        = {{721--730}},
  publisher    = {{Springer Science and Business Media B.V.}},
  series       = {{Intensive Care Medicine}},
  title        = {{Intravascular vs. surface cooling in out-of-hospital cardiac arrest patients receiving hypothermia after hospital arrival : a post hoc analysis of the TTM2 trial}},
  url          = {{http://dx.doi.org/10.1007/s00134-025-07883-4}},
  doi          = {{10.1007/s00134-025-07883-4}},
  volume       = {{51}},
  year         = {{2025}},
}