Editor’s Choice-Effects of targeted temperature management on mortality and neurological outcome: A systematic review and meta-analysis

Stanger, Dylan; Mihajlovic, Vesna; Singer, Joel; Desai, Sameer; El-Sayegh, Rami; Wong, Graham C.

doi:10.1177/2048872617744353

Cited by 10 publications

(6 citation statements)

References 61 publications

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“…Targeted temperature management (TTM) TTM refers to a therapeutic strategy that aims to achieve and maintain a specific core temperature in particular patients to improve clinical outcomes [73]. In recent years, people have gradually realized the importance of accurate body temperature management in the treatment of critically ill patients [74], which may be especially important for patients with HS, and TTM should be implemented for patients throughout hospitalization.…”

Section: In-hospital Treatmentmentioning

confidence: 99%

Expert consensus on the diagnosis and treatment of heat stroke in China

et al. 2020

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Heat stroke (HS) is a fatal disease caused by thermal damage in the body, and it has a very high mortality rate. In 2015, the People's Liberation Army Professional Committee of Critical Care Medicine published the first expert consensus on HS in China, Expert consensus on standardized diagnosis and treatment for heat stroke. With an increased understanding of HS and new issues that emerged during the HS treatment in China in recent years, the 2015 consensus no longer meet the requirements for HS prevention and treatment. It is necessary to update the consensus to include the latest research evidence and establish a new consensus that has broader coverage, is more practical and is more in line with China's national conditions. This new expert consensus includes new concept of HS, recommendations for laboratory tests and auxiliary examinations, new understanding of diagnosis and differential diagnosis, On-site emergency treatment and In-hospital treatment, translocation of HS patients and prevention of HS.

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Section: In-hospital Treatmentmentioning

confidence: 99%

Expert consensus on the diagnosis and treatment of heat stroke in China

et al. 2020

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“…The American Heart Association (AHA), the European Resuscitation Council (ERC), and the International Liaison Committee on Resuscitation (ILCOR) have provided postrecovery guidelines that recommend using TH or targeted temperature management (TTM) for follow-up treatment of eligible patients after CA resuscitation [11][12][13]. A related metaanalysis reviewed 1974 articles, including 6 randomized controlled trials (RCTs) and 8 observational studies, and showed low-quality evidence supporting the finding that OHCA survivors with initial shockable rhythms can improve their survival rate and neurological functional prognosis after hypothermia is induced and maintained for 18-24 h at 32-36°C after being admitted to hospital [14].…”

Section: Introductionmentioning

confidence: 99%

Effects of endovascular and surface cooling on resuscitation in patients with cardiac arrest and a comparison of effectiveness, stability, and safety: a systematic review and meta-analysis

Liao

Zhou

et al. 2020

Crit Care

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Objectives: This study conducted a meta-analysis to assess the effectiveness, stability, and safety of mild therapeutic hypothermia (TH) induced by endovascular cooling (EC) and surface cooling (SC) and its effect on ICU, survival rate, and neurological function integrity in adult CA patients. Methods: We developed inclusion criteria, intervention protocols, results, and data collection. The results included outcomes during target temperature management as well as ICU stay, survival rate, and neurological functional integrity. The characteristics of the included population and each study were analyzed. Results: Four thousand nine hundred thirteen participants met the inclusion criteria. Those receiving EC had a better cooling efficiency (cooling rates MD = 0.31[0.13, 0.50], p < 0.01; induced cooling times MD = − 90.45[− 167.57, − 13.33], p = 0.02; patients achieving the target temperature RR = 1.60[1.19, 2.15], p < 0.01) and thermal stability during the maintenance phase (maintenance time MD = 2.35[1.22, 3.48], p < 0.01; temperature fluctuation MD = − 0.68[− 1.03, − 0.33], p < 0.01; overcooling RR = 0.33[0.23, 0.49], p < 0.01). There were no differences in ICU survival rate (RR = 1.22[0.98, 1.52], p = 0.07, I 2 = 0%) and hospital survival rate (RR = 1.02 [0.96, 1.09], p = 0.46, I 2 = 0%), but EC reduced the length of stay in ICU (MD = − 1.83[− 3.45, − 0.21], p = 0.03, I 2 = 49%) and improved outcome of favorable neurological function at discharge (RR = 1.15[1.04, 1.28], p < 0.01, I 2 = 0%). EC may delay the hypothermia initiation time, and there was no significant difference between the two cooling methods in the time from the start of patients' cardiac arrest to achieve the target temperature (MD = − 46.64[− 175.86, 82.58]). EC was superior to non-ArcticSun in terms of cooling efficiency. Although there was no statistical difference in ICU survival rate, ICU length of stay, and hospitalization survival rate, in comparison to non-ArcticSun, EC improved rates of neurologically intact survival (RR = 1.16 [1.01, 1.35], p = 0.04, I 2 = 0%).

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“…These recommendations were primarily based on two classic TTM tests, in which patients were cooled for an average of 24 h [64,66]. Observational trials have also shown that the optimal duration for improvement is 18-24 h [70][71][72]. In 2017, a large multicenter RCT demonstrated that TTM (33 • C) maintained for 48 h, compared with 24 h, did not improve the prognosis of the nervous system at 6 months, and prolonged hypothermia increased the risk of adverse reactions [73].…”

Section: Maintenance Timementioning

confidence: 99%

Individualized management objectives for hypoxic-ischemic brain injury after cardiac arrest

2022

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Hypoxic-ischemic brain injury after cardiac arrest is the main cause of death and neurologic dysfunction in patients after the return of spontaneous circulation. The mechanisms of ischemic and hypoxic brain injury include hypoxia of brain tissue caused by the cessation of cerebral blood flow during the initial cardiac arrest and cerebrovascular dysfunction and reperfusion injury after the recovery of circulation. Cerebral circulatory perfusion, cerebral autoregulation, and cerebral edema can be monitored and controlled as therapeutic targets. In this study, from the aspects of body temperature, mean arterial pressure, oxygen concentration, partial pressure of carbon dioxide in the artery, and cerebral edema, monitoring methods such as measurement of cerebral oxygen saturation, assessment of cerebral blood flow, imaging of the brain, and measurement of intracranial pressure were introduced to explore individual management objectives for hypoxic-ischemic brain injury.

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Editor’s Choice-Effects of targeted temperature management on mortality and neurological outcome: A systematic review and meta-analysis

Cited by 10 publications

References 61 publications

Expert consensus on the diagnosis and treatment of heat stroke in China

Expert consensus on the diagnosis and treatment of heat stroke in China

Effects of endovascular and surface cooling on resuscitation in patients with cardiac arrest and a comparison of effectiveness, stability, and safety: a systematic review and meta-analysis

Individualized management objectives for hypoxic-ischemic brain injury after cardiac arrest

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