Hypothermic versus Normothermic Temperature Control after Cardiac Arrest
Holgersson, Johan LU ; Meyer, Martin Abild Stengaard ; Dankiewicz, Josef LU
; Lilja, Gisela
LU
; Ullén, Susann
LU
; Hassager, Christian
; Cronberg, Tobias
LU
; Wise, Matt P.
; Bělohlávek, Jan
and Hovdenes, Jan
, et al.
(2022)
In NEJM Evidence
1(11).
p.1-13
- Abstract
- BACKGROUND
The evidence for temperature control for comatose survivors of cardiac arrest is inconclusive. Controversy exists as to whether the effects of hypothermia differ per the circumstances of the cardiac arrest or patient characteristics.
METHODS
An individual patient data meta-analysis of the Targeted Temperature Management at 33°C versus 36°C after Cardiac Arrest (TTM) and Hypothermia versus Normothermia after Out-of-Hospital Cardiac Arrest (TTM2) trials was conducted. The intervention was hypothermia at 33°C and the comparator was normothermia. The primary outcome was all-cause mortality at 6 months. Secondary outcomes included poor functional outcome (modified Rankin scale score of 4 to 6) at 6 months. Predefined... (More) - BACKGROUND
The evidence for temperature control for comatose survivors of cardiac arrest is inconclusive. Controversy exists as to whether the effects of hypothermia differ per the circumstances of the cardiac arrest or patient characteristics.
METHODS
An individual patient data meta-analysis of the Targeted Temperature Management at 33°C versus 36°C after Cardiac Arrest (TTM) and Hypothermia versus Normothermia after Out-of-Hospital Cardiac Arrest (TTM2) trials was conducted. The intervention was hypothermia at 33°C and the comparator was normothermia. The primary outcome was all-cause mortality at 6 months. Secondary outcomes included poor functional outcome (modified Rankin scale score of 4 to 6) at 6 months. Predefined subgroups based on the design variables in the original trials were tested for interaction with the intervention as follows: age (older or younger than the median), sex (female or male), initial cardiac rhythm (shockable or nonshockable), time to return of spontaneous circulation (above or below the median), and circulatory shock on admission (presence or absence).
RESULTS
The primary analyses included 2800 patients, with 1403 assigned to hypothermia and 1397 to normothermia. Death occurred for 691 of 1398 participants (49.4%) in the hypothermia group and 666 of 1391 participants (47.9%) in the normothermia group (relative risk with hypothermia, 1.03; 95% confidence interval [CI], 0.96 to 1.11; P=0.41). A poor functional outcome occurred for 733 of 1350 participants (54.3%) in the hypothermia group and 718 of 1330 participants (54.0%) in the normothermia group (relative risk with hypothermia, 1.01; 95% CI, 0.94 to 1.08; P=0.88). Outcomes were consistent in the predefined subgroups.
CONCLUSIONS
Hypothermia at 33°C did not decrease 6-month mortality compared with normothermia after out-of-hospital cardiac arrest. (Funded by Vetenskapsrådet; ClinicalTrials.gov numbers NCT02908308 and NCT01020916.) (Less)
Please use this url to cite or link to this publication:
https://lup.lub.lu.se/record/7940623b-59a3-4ea4-b317-a2cbef468b01
- author
- Holgersson, Johan
LU
; Meyer, Martin Abild Stengaard
; Dankiewicz, Josef
LU
; Lilja, Gisela
LU
; Ullén, Susann
LU
; Hassager, Christian
; Cronberg, Tobias
LU
; Wise, Matt P.
; Bělohlávek, Jan
and Hovdenes, Jan
, et al. (More)
- Holgersson, Johan
LU
; Meyer, Martin Abild Stengaard
; Dankiewicz, Josef
LU
; Lilja, Gisela
LU
; Ullén, Susann
LU
; Hassager, Christian
; Cronberg, Tobias
LU
; Wise, Matt P.
; Bělohlávek, Jan
; Hovdenes, Jan
; Pelosi, Paolo
; Erlinge, David
LU
; Schrag, Claudia
; Smid, Ondrej
; Brunetti, Iole
; Rylander, Christian
; Young, Paul J.
; Saxena, Manoj
; Åneman, Anders
; Cariou, Alain
; Callaway, Clifton
; Eastwood, Glenn M.
; Haenggi, Matthias
; Joannidis, Michael
; Keeble, Thomas R.
; Kirkegaard, Hans
; Leithner, Christoph
; Levin, Helena
LU
; Nichol, Alistair D.
; Morgan, Matt P. G.
; Nordberg, Per
LU
; Oddo, Mauro
; Storm, Christian
; Taccone, Fabio Silvio
; Thomas, Matthew
; Bro-Jeppesen, John
; Horn, Janneke
; Kjaergaard, Jesper
; Kuiper, Michael
; Pellis, Tommaso
; Stammet, Pascal
; Wanscher, Michael Jaeger
; Friberg, Hans
LU
; Nielsen, Niklas
LU
and Jakobsen, Janus Christian
(Less)
- organization
- publishing date
- 2022
- type
- Contribution to journal
- publication status
- published
- subject
- in
- NEJM Evidence
- volume
- 1
- issue
- 11
- pages
- 1 - 13
- publisher
- Massachusetts Medical Society
- ISSN
- 2766-5526
- DOI
- 10.1056/EVIDoa2200137
- language
- English
- LU publication?
- yes
- id
- 7940623b-59a3-4ea4-b317-a2cbef468b01
- date added to LUP
- 2023-05-08 08:21:05
- date last changed
- 2023-05-08 08:29:18
@article{7940623b-59a3-4ea4-b317-a2cbef468b01,
abstract = {{BACKGROUND<br/>The evidence for temperature control for comatose survivors of cardiac arrest is inconclusive. Controversy exists as to whether the effects of hypothermia differ per the circumstances of the cardiac arrest or patient characteristics.<br/>METHODS<br/>An individual patient data meta-analysis of the Targeted Temperature Management at 33°C versus 36°C after Cardiac Arrest (TTM) and Hypothermia versus Normothermia after Out-of-Hospital Cardiac Arrest (TTM2) trials was conducted. The intervention was hypothermia at 33°C and the comparator was normothermia. The primary outcome was all-cause mortality at 6 months. Secondary outcomes included poor functional outcome (modified Rankin scale score of 4 to 6) at 6 months. Predefined subgroups based on the design variables in the original trials were tested for interaction with the intervention as follows: age (older or younger than the median), sex (female or male), initial cardiac rhythm (shockable or nonshockable), time to return of spontaneous circulation (above or below the median), and circulatory shock on admission (presence or absence).<br/>RESULTS<br/>The primary analyses included 2800 patients, with 1403 assigned to hypothermia and 1397 to normothermia. Death occurred for 691 of 1398 participants (49.4%) in the hypothermia group and 666 of 1391 participants (47.9%) in the normothermia group (relative risk with hypothermia, 1.03; 95% confidence interval [CI], 0.96 to 1.11; P=0.41). A poor functional outcome occurred for 733 of 1350 participants (54.3%) in the hypothermia group and 718 of 1330 participants (54.0%) in the normothermia group (relative risk with hypothermia, 1.01; 95% CI, 0.94 to 1.08; P=0.88). Outcomes were consistent in the predefined subgroups.<br/>CONCLUSIONS<br/>Hypothermia at 33°C did not decrease 6-month mortality compared with normothermia after out-of-hospital cardiac arrest. (Funded by Vetenskapsrådet; ClinicalTrials.gov numbers NCT02908308 and NCT01020916.)}},
author = {{Holgersson, Johan and Meyer, Martin Abild Stengaard and Dankiewicz, Josef and Lilja, Gisela and Ullén, Susann and Hassager, Christian and Cronberg, Tobias and Wise, Matt P. and Bělohlávek, Jan and Hovdenes, Jan and Pelosi, Paolo and Erlinge, David and Schrag, Claudia and Smid, Ondrej and Brunetti, Iole and Rylander, Christian and Young, Paul J. and Saxena, Manoj and Åneman, Anders and Cariou, Alain and Callaway, Clifton and Eastwood, Glenn M. and Haenggi, Matthias and Joannidis, Michael and Keeble, Thomas R. and Kirkegaard, Hans and Leithner, Christoph and Levin, Helena and Nichol, Alistair D. and Morgan, Matt P. G. and Nordberg, Per and Oddo, Mauro and Storm, Christian and Taccone, Fabio Silvio and Thomas, Matthew and Bro-Jeppesen, John and Horn, Janneke and Kjaergaard, Jesper and Kuiper, Michael and Pellis, Tommaso and Stammet, Pascal and Wanscher, Michael Jaeger and Friberg, Hans and Nielsen, Niklas and Jakobsen, Janus Christian}},
issn = {{2766-5526}},
language = {{eng}},
number = {{11}},
pages = {{1--13}},
publisher = {{Massachusetts Medical Society}},
series = {{NEJM Evidence}},
title = {{Hypothermic versus Normothermic Temperature Control after Cardiac Arrest}},
url = {{http://dx.doi.org/10.1056/EVIDoa2200137}},
doi = {{10.1056/EVIDoa2200137}},
volume = {{1}},
year = {{2022}},
}