Effect of cooling methods and target temperature on outcomes in comatose patients resuscitated from cardiac arrest: Systematic review and network meta-analysis of randomized trials

被引：8

作者：

Matsumoto, Shingo ^{[1
]}

Kuno, Toshiki ^{[2
,9
]}

Mikami, Takahisa ^{[3
]}

Takagi, Hisato ^{[4
]}

Ikeda, Takanori ^{[1
]}

Briasoulis, Alexandros ^{[5
]}

Bortnick, Anna E. ^{[2
]}

Sims, Daniel ^{[2
]}

Katz, Jason N. ^{[6
]}

Jentzer, Jacob ^{[7
]}

Bangalore, Sripal ^{[8
]}

Alviar, Carlos L. ^{[8
]}

机构：

[1] Toho Univ, Fac Med, Dept Internal Med, Div Cardiovasc Med, Tokyo, Japan

[2] Montefiore Med Ctr, Dept Med, Div Cardiol, Bronx, NY USA

[3] Tufts Med Ctr, Dept Neurol, Boston, MA USA

[4] Shizuoka Med Ctr, Dept Cardiovasc Surg, Shizuoka, Japan

[5] Univ Iowa, Div Cardiol Heart Failure & Transplantat, Iowa City, IA USA

[6] Duke Univ, Div Cardiovasc Med, Durham, NC USA

[7] Mayo Clin, Dept Cardiovasc Med, Rochester, MN USA

[8] New York Univ, Grossman Sch Med, Leon H Charney Div Cardiovasc Med, New York, NY USA

[9] Albert Einstein Coll Med, Montefiore Med Ctr, Dept Cardiol, 111 East 210th St, Bronx, NY 10467 USA

来源：

AMERICAN HEART JOURNAL | 2023年 / 256卷

关键词：

THERAPEUTIC HYPOTHERMIA; CARDIOPULMONARY-RESUSCITATION; MANAGEMENT; SURVIVORS;

D O I：

10.1016/j.ahj.2022.11.005

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background Targeted temperature management (TTM) has been recommended after cardiac arrest (CA), however the specific temperature targets and cooling methods (intravascular cooling (IVC) versus surface cooling (SC)) remain uncertain.Methods PUBMED and EMBASE were searched until October 8, 2022 for randomized clinical trials (RCTs) investigating the efficacy of TTM after CA. The randomized treatment arms were categorized into the following 6 groups: 31 degrees C to 33 degrees C IVC, 31 degrees C to 33 degrees C SC, 34 degrees C to 36 degrees C IVC, 34 degrees C to 36 degrees C SC, strict normothermia or fever prevention (Strict NT or FP), and standard of care without TTM (No-TTM). The primary outcome was neurological recovery. P-score was used to rank the treatments, where a larger value indicates better performance.Results We identified 15 RCTs, involving 5,218 patients with CA. Compared to No-TTM as the reference, the other therapeutic options significantly improved neurological outcomes (vs No-TTM; 31 degrees C to 33 degrees C IVC: RR = 0.67, 95% CI 0.54 to 0.83; 31 degrees C to 33 degrees C SC RR = 0.73, 95% CI 0.61 to 0.87; 34 degrees C to 36 degrees C IVC: RR = 0.66, 95% CI 0.51 to 0.86; 34 degrees C to 36 degrees C SC: RR = 0.73, 0.59 to 0.90; Strict NT or FP: RR = 0.75, 95% CI 0.62 to 0.90). Overall, 31-33 degrees C IVC had the highest probability to be the best therapeutic option to improve outcomes (the ranking P-score of 0.836). As a subgroup analysis, the ranking P-score showed that IVC might be a better cooling method compared to SC (IVC vs SC P-score: 0.960 vs 0.670).Conclusions Hypothermia (31 degrees C to 36 degrees C IVC and SC) and active normothermia (Strict-NT and Strict-FP) were asso-ciated with better neurological outcomes compared to No-TTM, with IVC having a greater probability of being the better cooling method than SC. (Am Heart J 2023;256:73-84.)

引用

页码：73 / 84

页数：12

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