Systematic review of randomized controlled trials of therapeutic hypothermia as a neuroprotectant in post cardiac arrest patients

Abstract

Objective: Several randomized controlled trials have suggested that mild induced hypothermia may improve neurologic outcome in comatose cardiac arrest survivors. This systematic review of randomized controlled trials was designed to determine if mild induced hypothermia improves neurologic outcome, decreases mortality, or is associated with an increased incidence of adverse events. Science (1989 to November 2005. For each included study, references were reviewed and the primary author contacted to identify any additional studies. Study selection: Studies that met inclusion criteria were randomized controlled trials of adult patients (>18 years of age) with primary cardiac arrest who remained comatose after return of spontaneous circulation. Patients had to be randomized to mild induced hypothermia (32°C-34°C) or normothermia within 24 hours of presentation. Only studies reporting pre-determined outcomes including discharge neurologic outcome, mortality or significant treatment-related adverse events were included. There were no language or publication restrictions. Data synthesis: Four studies involving 436 patients, with 232 cooled to a core temperature of 32°C-34°C met inclusion criteria. Pooled data demonstrated that mild hypothermia decreased inhospital mortality (relative ratio [RR] 0.75; 95% confidence interval [CI], 0.62-0.92) and reduced the incidence of poor neurologic outcome (RR 0.74; 95% CI, 0.62-0.84). Numbers needed to treat were 7 patients to save 1 life, and 5 patients to improve neurologic outcome. There was no evidence of treatment-limiting side effects. Conclusions: Therapeutically induced mild hypothermia decreases in-hospital mortality and improves neurologic outcome in comatose cardiac arrest survivors. The possibility of treatment-limiting side effects cannot be excluded. RÉSUMÉObjectif : Plusieurs essais comparatifs randomisés ont suggéré qu'une légère hypothermie provoquée peut améliorer le résultat clinique chez les victimes d'arrêt cardiaque dans le coma. La

Prophylactic hypothermia for traumatic brain injury: a quantitative systematic review

“…Previous meta-analyses have used GOS (di chotomized into good [GOS score [4][5] or poor [GOS score [1][2][3]) as a simplified measure of neurologic outcome after TBI. [4][5][6][7] We also sought to determine whether there is a difference in the efficacy of shortterm cooling compared with a long-term or goaldirected strategy.…”

“…Induced hypothermia is now an accepted measure to improve outcome following anoxic brain injury associated with cardiac arrest, [1][2][3] but its benefits in TBI are uncertain. Several older metaanalyses concluded that hypothermia is not effective for TBI.…”

Serotonergic System Does Not Contribute to the Hypothermic Action of Acetaminophen

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“…9 In response, cooling was developed as a neuroprotection for ischemic cerebral tissues. Cheung et al 10 did systematic review of randomized controlled trials and found that despite differences in cooling protocols between the studies, the pooled results demonstrated that mild hypothermia is associated with statistically significant and clinically important decreases in hospital mortality and improvements in neurological outcome after cardiac arrest. 10 Despite the fact that TTM is a changing landscape, nursing care must continue to be delivered.…”