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

Matsumoto, Shingo; Kuno, Toshiki; Mikami, Takahisa; Takagi, Hisato; Ikeda, Takanori; Briasoulis, Αlexandros; Bortnick, Anna E.; Sims, Daniel B.; Katz, Jason N.; Jentzer, Jacob C.; Bangalore, Sripal; Alviar, Carlos L.

doi:10.1016/j.ahj.2022.11.005

Cited by 6 publications

(2 citation statements)

References 36 publications

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“…Due to their pragmatic nature, clinical trials in temperature control have been agnostic to the type of devices for temperature modulation. Several recent meta-analyses have demonstrated that intravascular cooling leads to better neurological outcomes compared to surface cooling, likely due to the intravascular route being more precise in maintaining the desired temperature, causing less temperature variation and being less associated with shivering [ 61 , 62 ]. Several studies that evaluated surface cooling did not indicate whether temperature feedback was utilized [ 62 ].…”

Section: Methodsmentioning

confidence: 99%

Temperature Control After Cardiac Arrest: A Narrative Review

et al. 2023

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Cardiac arrest (CA) is a critical public health issue affecting more than half a million Americans annually. The main determinant of outcome post-CA is hypoxic-ischemic brain injury (HIBI), and temperature control is currently the only evidence-based, guideline-recommended intervention targeting secondary brain injury. Temperature control is a key component of a post-CA care bundle; however, conflicting evidence challenges its wide implementation across the vastly heterogeneous population of CA survivors. Here, we critically appraise the available literature on temperature control in HIBI, detail how the evidence has been integrated into clinical practice, and highlight the complications associated with its use and the timing of neuroprognostication after CA. Future clinical trials evaluating different temperature targets, rates of rewarming, duration of cooling, and identifying which patient phenotype benefits from different temperature control methods are needed to address these prevailing knowledge gaps.

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Section: Methodsmentioning

confidence: 99%

Temperature Control After Cardiac Arrest: A Narrative Review

et al. 2023

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“…62 In another systematic review and meta-analysis, which only included randomized controlled trials, all modes of temperature control were superior to no temperature control; among cooling modes, IVTM was superior to surface cooling (ranking p-score 0.960 vs 0.670). 63…”

Section: Device Selectionmentioning

confidence: 99%

Temperature Control in the Era of Personalized Medicine: Knowledge Gaps, Research Priorities, and Future Directions

Beekman,

Khosla,

Buckley

et al. 2023

J Intensive Care Med

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Hypoxic–ischemic brain injury (HIBI) is the leading cause of death and disability after cardiac arrest. To date, temperature control is the only intervention shown to improve neurologic outcomes in patients with HIBI. Despite robust preclinical evidence supporting hypothermia as neuroprotective therapy after cardiac arrest, there remains clinical equipoise regarding optimal core temperature, therapeutic window, and duration of therapy. Current guidelines recommend continuous temperature monitoring and active fever prevention for at least 72 h and additionally note insufficient evidence regarding temperature control targeting 32 °C-36 °C. However, population-based thresholds may be inadequate to support the metabolic demands of ischemic, reperfused, and dysregulated tissue. Promoting a more personalized approach with individualized targets has the potential to further improve outcomes. This review will analyze current knowledge and evidence, address research priorities, explore the components of high-quality temperature control, and define critical future steps that are needed to advance patient-centered care for cardiac arrest survivors.

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