Impact of therapeutic hypothermia during cardiopulmonary resuscitation on neurologic outcome: A systematic review and meta-analysis

Annoni, Filippo; Peluso, Lorenzo; Fiore, Marco; Nordberg, Per; Svensson, Leif; Abella, Benjamin S.; Calabrò, Lorenzo; Scolletta, Sabino; Vincent, Jean‐Louis; Créteur, Jacques; Taccone, Fabio Silvio

doi:10.1016/j.resuscitation.2021.01.029

Cited by 9 publications

(5 citation statements)

References 31 publications

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“…Therapeutic hypothermia has been investigated as a protective intervention in various forms of acute cardiac dis-ease such as myocardial infarction, 19 cardiac arrest with or without cardiogenic shock, [20][21][22] and cardiogenic shock. 3,23,24 Cardiac arrest studies led to the concept of targeted temperature management in which both 33 °C and 36 °C resulted in similar outcomes.…”

Section: Discussionmentioning

confidence: 99%

Effect of Moderate Hypothermia vs Normothermia on 30-Day Mortality in Patients With Cardiogenic Shock Receiving Venoarterial Extracorporeal Membrane Oxygenation

Lévy

Girerd

Amour

et al. 2022

JAMA

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HAL is a multi-disciplinary open access archive for the deposit and dissemination of scientific research documents, whether they are published or not. The documents may come from teaching and research institutions in France or abroad, or from public or private research centers. L'archive ouverte pluridisciplinaire HAL, est destinée au dépôt et à la diffusion de documents scientifiques de niveau recherche, publiés ou non, émanant des établissements d'enseignement et de recherche français ou étrangers, des laboratoires publics ou privés.

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Section: Discussionmentioning

confidence: 99%

Effect of Moderate Hypothermia vs Normothermia on 30-Day Mortality in Patients With Cardiogenic Shock Receiving Venoarterial Extracorporeal Membrane Oxygenation

Lévy

Girerd

Amour

et al. 2022

JAMA

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“…Experimental data suggested that hypothermia initiated during CPR (i.e. “intra-arrest cooling”) would provide additional beneficial effects against post-anoxic brain injury [ 10 ]. However, data from human studies are limited [ 10 , 11 ] and inconclusive; moreover, not all methods to induce intra-arrest cooling may produce the same effects on brain recovery after cardiac arrest (CA).…”

Section: Introductionmentioning

confidence: 99%

“…“intra-arrest cooling”) would provide additional beneficial effects against post-anoxic brain injury [ 10 ]. However, data from human studies are limited [ 10 , 11 ] and inconclusive; moreover, not all methods to induce intra-arrest cooling may produce the same effects on brain recovery after cardiac arrest (CA). In one study, Bernard et al showed that intra-arrest cooling using cold fluids was associated with a decrease in ROSC, in particular for patients with shockable rhythm, with no significant difference in survival at hospital discharge with the control group [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

“…In one study, Bernard et al showed that intra-arrest cooling using cold fluids was associated with a decrease in ROSC, in particular for patients with shockable rhythm, with no significant difference in survival at hospital discharge with the control group [ 12 ]. In a recent systematic review including two RCTs [ 13 , 14 ], intra-arrest cooling using trans-nasal evaporative cooling was associated in two RCTs with a non-significant trend towards a higher proportion of OHCA patients achieving favourable neurologic outcome when compared to patients where TTM was initiated after hospital arrival [ 10 ]. Moreover, the benefits of this intervention were observed in particular among those patients with an initial shockable rhythm [ 13 , 14 ], although this has been not been further evaluated.…”

Section: Introductionmentioning

confidence: 99%

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Effect of intra-arrest trans-nasal evaporative cooling in out-of-hospital cardiac arrest: a pooled individual participant data analysis

et al. 2021

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Background Randomized trials have shown that trans-nasal evaporative cooling initiated during CPR (i.e. intra-arrest) effectively lower core body temperature in out-of-hospital cardiac arrest patients. However, these trials may have been underpowered to detect significant differences in neurologic outcome, especially in patients with initial shockable rhythm. Methods We conducted a post hoc pooled analysis of individual data from two randomized trials including 851 patients who eventually received the allocated intervention and with available outcome (“as-treated” analysis). Primary outcome was survival with favourable neurological outcome at hospital discharge (Cerebral Performance Category [CPC] of 1–2) according to the initial rhythm (shockable vs. non-shockable). Secondary outcomes included complete neurological recovery (CPC 1) at hospital discharge. Results Among the 325 patients with initial shockable rhythms, favourable neurological outcome was observed in 54/158 (34.2%) patients in the intervention and 40/167 (24.0%) in the control group (RR 1.43 [confidence intervals, CIs 1.01–2.02]). Complete neurological recovery was observed in 40/158 (25.3%) in the intervention and 27/167 (16.2%) in the control group (RR 1.57 [CIs 1.01–2.42]). Among the 526 patients with initial non-shockable rhythms, favourable neurological outcome was in 10/259 (3.8%) in the intervention and 13/267 (4.9%) in the control group (RR 0.88 [CIs 0.52–1.29]; p = 0.67); survival and complete neurological recovery were also similar between groups. No significant benefit was observed for the intervention in the entire population. Conclusions In this pooled analysis of individual data, intra-arrest cooling was associated with a significant increase in favourable neurological outcome in out-of-hospital cardiac arrest patients with initial shockable rhythms. Future studies are needed to confirm the potential benefits of this intervention in this subgroup of patients.

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“…It is worth noting that ''therapeutic hypothermia'', ''cooling'' and ''targeted temperature management'' have been used in the past to reflect the practice of controlling temperature, passively or actively, within a certain range, most often between 32 and 36 °C; these are falling out of favor given the changing landscape in post-CA care, where target temperatures may not be in the hypothermic range and the term ''targeted temperature management'' may suggest practices following the study protocol of specific clinical trials. The premise of temperature control is to mitigate HIBI by minimizing mitochondrial injury, cerebral metabolism, formation of free radicals, and neuronal excitotoxicity pathways that are temperature dependent [7,[11][12][13]. In this scoping review, we characterize the mechanisms implicated in HIBI and dissect post-CA care, with a focus on temperature control and its phases, as well as the implications for neurologic outcome prediction.…”

Section: Introductionmentioning

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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Impact of therapeutic hypothermia during cardiopulmonary resuscitation on neurologic outcome: A systematic review and meta-analysis

Cited by 9 publications

References 31 publications

Effect of Moderate Hypothermia vs Normothermia on 30-Day Mortality in Patients With Cardiogenic Shock Receiving Venoarterial Extracorporeal Membrane Oxygenation

Effect of Moderate Hypothermia vs Normothermia on 30-Day Mortality in Patients With Cardiogenic Shock Receiving Venoarterial Extracorporeal Membrane Oxygenation

Effect of intra-arrest trans-nasal evaporative cooling in out-of-hospital cardiac arrest: a pooled individual participant data analysis

Temperature Control After Cardiac Arrest: A Narrative Review

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