Does therapeutic temperature management after cardiac arrest increase the risk of bleeding?

Abstract

Cardiac arrest is a significant public health issue, with a high case fatality (>90% overall). 1 Guidelines recommend targeted temperature management (TTM) in the post-resuscitation care of patients who have suffered a cardiac arrest. 2-5 Several studies 6-8 have shown improved survival and neurological outcomes with the use of therapeutic hypothermia, also known as TTM. 9 Possible complications of TTM include bleeding, shivering and infection. 10-12 Hypothermia-induced coagulation disorder could enhance the risk for serious adverse events. 5,12-14 but it is unclear if bleeding complications occur more often in patients suffering cardiac arrest who have TTM. This report critiques a systematic review and meta-analysis that examined the relationship of bleeding with TTM: Therapeutic temperature management after cardiac arrest and the risk of bleeding: Systematic review and meta-analysis for the effect of therapeutic temperature management after cardiac arrest. 10 Study summary Aim: The systematic review and meta-analysis aimed to examine whether TTM after cardiac arrest increased the risk of bleeding. Method: Data for the systematic review and meta-analysis were obtained by a systematic literature search in September 2013 using MEDLINE, EMBASE and CENTRAL databases. The level of evidence and quality were assessed using the International Liaison Committee on Resuscitation (ILCOR) Guidelines. The risk of bleeding while receiving TTM or no TTM was examined in two meta-analyses. Results: Of 941 studies, 34 met the selection criteria and were included in the systematic review. Bleeding was found to be higher in patients treated with TTM (RR: 1.30, 95% CI: 0.97-1.74) in a meta-analysis of 5 studies (599 patients) but this did not reach statistical significance (p = 0.085). In a second meta-analysis of bleeding requiring transfusion (7 studies, 599 patients), there was no significant difference in the incidence of severe bleeding (RR 0.97, 95% CI: 0.61-1.56, p = 0.909). Conclusion: The risk of bleeding was not significantly higher for patients undergoing TTM. Regarding the risk of bleeding, the authors asserted that TTM is a safe method for patients after cardiac arrest.

Successful fibrinolytic and therapeutic hypothermic management of cardiac arrest following massive pulmonary embolism

“…It has been reported that a hypothermia-induced coagulation disorder could increase the risk of serious adverse events [ 4 ], but it is unclear if bleeding complications occur more often in cardiac arrest patients treated with therapeutic hypothermia. In a recent systematic review and meta-analysis, the risk of bleeding was not significantly higher for patients treated with therapeutic hypothermia [ 9 ]. Relative contraindications to fibrinolytic therapy include prolonged CPR (>10 minutes) and major surgery within three weeks prior to cardiac arrest [ 3 ].…”