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Targeted Temperature Management at 33 degrees C versus 36 degrees C after Cardiac Arrest

Nielsen, Niklas LU ; Wettersley, Jorn; Cronberg, Tobias LU ; Erlinge, David LU ; Gasche, Yvan; Hassager, Christian; Horn, Janneke; Hovdenes, Jan; Kjaergaard, Jesper and Kuiper, Michael, et al. (2013) In New England Journal of Medicine 369(23). p.2197-2206
Abstract
BackgroundUnconscious survivors of out-of-hospital cardiac arrest have a high risk of death or poor neurologic function. Therapeutic hypothermia is recommended by international guidelines, but the supporting evidence is limited, and the target temperature associated with the best outcome is unknown. Our objective was to compare two target temperatures, both intended to prevent fever. MethodsIn an international trial, we randomly assigned 950 unconscious adults after out-of-hospital cardiac arrest of presumed cardiac cause to targeted temperature management at either 33 degrees C or 36 degrees C. The primary outcome was all-cause mortality through the end of the trial. Secondary outcomes included a composite of poor neurologic function or... (More)
BackgroundUnconscious survivors of out-of-hospital cardiac arrest have a high risk of death or poor neurologic function. Therapeutic hypothermia is recommended by international guidelines, but the supporting evidence is limited, and the target temperature associated with the best outcome is unknown. Our objective was to compare two target temperatures, both intended to prevent fever. MethodsIn an international trial, we randomly assigned 950 unconscious adults after out-of-hospital cardiac arrest of presumed cardiac cause to targeted temperature management at either 33 degrees C or 36 degrees C. The primary outcome was all-cause mortality through the end of the trial. Secondary outcomes included a composite of poor neurologic function or death at 180 days, as evaluated with the Cerebral Performance Category (CPC) scale and the modified Rankin scale. ResultsIn total, 939 patients were included in the primary analysis. At the end of the trial, 50% of the patients in the 33 degrees C group (235 of 473 patients) had died, as compared with 48% of the patients in the 36 degrees C group (225 of 466 patients) (hazard ratio with a temperature of 33 degrees C, 1.06; 95% confidence interval [CI], 0.89 to 1.28; P=0.51). At the 180-day follow-up, 54% of the patients in the 33 degrees C group had died or had poor neurologic function according to the CPC, as compared with 52% of patients in the 36 degrees C group (risk ratio, 1.02; 95% CI, 0.88 to 1.16; P=0.78). In the analysis using the modified Rankin scale, the comparable rate was 52% in both groups (risk ratio, 1.01; 95% CI, 0.89 to 1.14; P=0.87). The results of analyses adjusted for known prognostic factors were similar. ConclusionsIn unconscious survivors of out-of-hospital cardiac arrest of presumed cardiac cause, hypothermia at a targeted temperature of 33 degrees C did not confer a benefit as compared with a targeted temperature of 36 degrees C. (Funded by the Swedish Heart-Lung Foundation and others; TTM ClinicalTrials.gov number, NCT01020916.) (Less)
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New England Journal of Medicine
volume
369
issue
23
pages
2197 - 2206
publisher
Massachusetts Medical Society
external identifiers
  • wos:000327801100006
  • scopus:84889259187
ISSN
0028-4793
DOI
10.1056/NEJMoa1310519
language
English
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yes
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38113e11-3cf1-43e3-88fd-9a1f9e7a7427 (old id 4272382)
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2014-02-10 12:20:00
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2019-09-22 03:07:54
@article{38113e11-3cf1-43e3-88fd-9a1f9e7a7427,
  abstract     = {BackgroundUnconscious survivors of out-of-hospital cardiac arrest have a high risk of death or poor neurologic function. Therapeutic hypothermia is recommended by international guidelines, but the supporting evidence is limited, and the target temperature associated with the best outcome is unknown. Our objective was to compare two target temperatures, both intended to prevent fever. MethodsIn an international trial, we randomly assigned 950 unconscious adults after out-of-hospital cardiac arrest of presumed cardiac cause to targeted temperature management at either 33 degrees C or 36 degrees C. The primary outcome was all-cause mortality through the end of the trial. Secondary outcomes included a composite of poor neurologic function or death at 180 days, as evaluated with the Cerebral Performance Category (CPC) scale and the modified Rankin scale. ResultsIn total, 939 patients were included in the primary analysis. At the end of the trial, 50% of the patients in the 33 degrees C group (235 of 473 patients) had died, as compared with 48% of the patients in the 36 degrees C group (225 of 466 patients) (hazard ratio with a temperature of 33 degrees C, 1.06; 95% confidence interval [CI], 0.89 to 1.28; P=0.51). At the 180-day follow-up, 54% of the patients in the 33 degrees C group had died or had poor neurologic function according to the CPC, as compared with 52% of patients in the 36 degrees C group (risk ratio, 1.02; 95% CI, 0.88 to 1.16; P=0.78). In the analysis using the modified Rankin scale, the comparable rate was 52% in both groups (risk ratio, 1.01; 95% CI, 0.89 to 1.14; P=0.87). The results of analyses adjusted for known prognostic factors were similar. ConclusionsIn unconscious survivors of out-of-hospital cardiac arrest of presumed cardiac cause, hypothermia at a targeted temperature of 33 degrees C did not confer a benefit as compared with a targeted temperature of 36 degrees C. (Funded by the Swedish Heart-Lung Foundation and others; TTM ClinicalTrials.gov number, NCT01020916.)},
  author       = {Nielsen, Niklas and Wettersley, Jorn and Cronberg, Tobias and Erlinge, David and Gasche, Yvan and Hassager, Christian and Horn, Janneke and Hovdenes, Jan and Kjaergaard, Jesper and Kuiper, Michael and Pellis, Tommaso and Stammet, Pascal and Wanscher, Michael and Wise, Matt P. and Aneman, Anders and Al-Subaie, Nawaf and Boesgaard, Soren and Bro-Jeppesen, John and Brunetti, Iole and Bugge, Jan Frederik and Hingston, Christopher D. and Juffermans, Nicole P. and Koopmans, Matty and Kober, Lars and Langorgen, Jorund and Lilja, Gisela and Moller, Jacob Eifer and Rundgren, Malin and Rylander, Christian and Smid, Ondrej and Werer, Christophe and Winkel, Per and Friberg, Hans},
  issn         = {0028-4793},
  language     = {eng},
  number       = {23},
  pages        = {2197--2206},
  publisher    = {Massachusetts Medical Society},
  series       = {New England Journal of Medicine},
  title        = {Targeted Temperature Management at 33 degrees C versus 36 degrees C after Cardiac Arrest},
  url          = {http://dx.doi.org/10.1056/NEJMoa1310519},
  volume       = {369},
  year         = {2013},
}