Therapeutic Hypothermia May Improve Neurological Outcomes in Extracorporeal Life Support for Adult Cardiac Arrest

Pang, Philip Y.K.; Wee, Gillian H.L.; Huang, Ming Jie; Hoo, Anne E.E.; Sheriff, Ismail Mohamed Tahir; Lim, See Lim; Tan, Teing Ee; Loh, Yee Jim; Chao, Victor; Soon, Jia-Lin; Kerk, Ka Lee; Salam, Zakir Hussain Abdul; Sin, Yoong Kong; Lim, Chong Hee

doi:10.1016/j.hlc.2016.11.022

Cited by 29 publications

(44 citation statements)

References 22 publications

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“…In our study TTM improved the neurological outcomes significantly. This is contrary to previous studies that showed worse neurological outcomes in TTM patients [19,20], and in accordance with Pang et al [11]. The randomized trials selected for this analysis had data for in-hospital and out-of-hospital cardiac arrest patients.…”

Section: Discussionsupporting

confidence: 50%

Targeted temperature management after cardiac arrest: Updated meta-analysis of all-cause mortality and neurological outcomes

Abdalla

Mohamed

et al. 2019

IJC Heart & Vasculature

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Background Cardiac arrest carries high mortality and morbidity burden. Different studies showed conflicting data regarding outcomes of targeted temperature management (TTM) for cardiac arrest. The purpose of this meta-analysis is to systematically determine the effect of TTM on all-cause mortality and neurological outcomes after cardiac arrest. Methods We conducted a systematic search for randomized controlled trials in Pubmed, Cochrane & ScienceDirect. Primary outcomes were neurological outcome and all-cause mortality. Results Nine randomized controlled trials utilizing data for in-hospital and out-of-hospital cardiac arrest were selected for meta-analysis. Total number of patients included was 1592. Mortality was lower in targeted temperature management group (OR 0.637, 95% CI 0.436–0.93, p-value 0.019, I 2 = 44.78%, n = 1592). Therapeutic hypothermia group also demonstrated reduction in poor neurological outcomes (OR 0.582, 95% CI 0.363–931, p-value 0.024, I 2 = 56.79%, n = 1567). Subgroup analysis was conducted, after excluding in-hospital cardiac arrest patients, and demonstrated reduction in poor neurological outcome (OR 0.562, 95% CI 0.331–0.955, p-value 0.033, I 2 = 61.78%, n = 1480) and mortality in out-of-hospital cardiac arrest patients (OR 0.674, 95% CI 0.454–999, p-value 0.049, I 2 = 43.8%, n = 1505). Conclusion Targeted temperature management after cardiac arrest may be associated with improvement in all-cause mortality and reduction in poor neurological outcome.

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Section: Discussionsupporting

confidence: 50%

Targeted temperature management after cardiac arrest: Updated meta-analysis of all-cause mortality and neurological outcomes

Abdalla

Mohamed

et al. 2019

IJC Heart & Vasculature

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“…Two studies did not state the specific temperature of therapeutic hypothermia and control arms [84,85]. Finally, 13 papers containing 1159 cases were included in the present study [9,[25][26][27][28][29][30][31][32][33][34][35][36]. Notably, two papers published by Kagawa et al in 2012 and 2015 with some overlapped participants were both included because they reported different clinical outcomes [25,27]…”

Section: Discussionmentioning

confidence: 99%

“…Of the 13 included studies, seven studies describe the indications of therapeutic hypothermia treatments [9,25,27,29,31,34,36]. All the unconscious patients after ECPR are recommended receiving therapeutic hypothermia in six studies and one study [31] randomly divides the unconscious CA patients into therapeutic hypothermia group and non-therapeutic hypothermia group. In other words, the patients in therapeutic hypothermia arms usually have a poorer neurological status at baseline than those in control arms, which might act as a bias when evaluating the associations of therapeutic hypothermia with patients' outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…ECPR is an ideal tool for rapid and homogenous cooling and can also be augmented with surface cooling. Up to now, there are some studies evaluating the combined use of ECPR and therapeutic hypothermia in adult CA patients and/or comparing therapeutic hypothermia treatment with no therapeutic hypothermia induction [9,[25][26][27][28][29][30][31][32][33][34][35][36][37]. However, the sample size of those studies is limited, the proportion of patients receiving therapeutic hypothermia ranges variously, and no conclusive result is derived whether there is a benefit of therapeutic hypothermia treatment in CA patients undergoing ECPR.…”

Section: Introductionmentioning

confidence: 99%

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Associations of therapeutic hypothermia with clinical outcomes in patients receiving ECPR after cardiac arrest: systematic review with meta-analysis

Chen

Zhen

Jia

et al. 2020

Scand J Trauma Resusc Emerg Med

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Background: Therapeutic hypothermia has been recommended for eligible patients after cardiac arrest (CA) in order to improve outcomes. Up to now, several comparative observational studies have evaluated the combined use of extracorporeal cardiopulmonary resuscitation (ECPR) and therapeutic hypothermia in adult patients with CA. However, the effects of therapeutic hypothermia in adult CA patients receiving ECPR are inconsistent. Methods: Relevant studies in English databases (PubMed, ISI web of science, OVID, and Embase) were systematically searched up to September 2019. Odds ratios (ORs) from eligible studies were extracted and pooled to summarize the associations of therapeutic hypothermia with favorable neurological outcomes and survival in adult CA patients receiving ECPR.Results: 13 articles were included in the present meta-analysis study. There were nine studies with a total of 806 cases reporting the association of therapeutic hypothermia with neurological outcomes in CA patients receiving ECPR. Pooling analysis suggested that therapeutic hypothermia was significantly associated with favorable neurological outcomes in overall (N = 9, OR = 3.507, 95%CI = 2.194-5.607, P < 0.001, fixed-effects model) and in all subgroups according to control type, regions, sample size, CA location, ORs obtained methods, follow-up period, and modified Newcastle Ottawa Scale (mNOS) scores. There were nine studies with a total of 806 cases assessing the association of therapeutic hypothermia with survival in CA patients receiving ECPR. After pooling the ORs, therapeutic hypothermia was found to be significantly associated with survival in overall (N = 9, OR = 2.540, 95%CI = 1.245-5.180, P = 0.010, random-effects model) and in some subgroups. Publication bias was found when evaluating the association of therapeutic hypothermia with neurological outcomes in CA patients receiving ECPR. Additional trim-and-fill analysis estimated four "missing" studies, which adjusted the effect size to 2.800 (95%CI = 1.842-4.526, P < 0.001, fixed-effects model) for neurological outcomes.Conclusions: Therapeutic hypothermia may be associated with favorable neurological outcomes and survival in adult CA patients undergoing ECPR. However, the result should be treated carefully because it is a synthesis of low-level evidence and other limitations exist in present study. It is necessary to perform randomized controlled trials to validate our result before considering the result in clinical practices.

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“…According to the Extracorporeal Life Support Organization Registry (6), therapeutic hypothermia has been used in over half the reported cases of pediatric ECPR, despite lack of documented benefit in this situation. In observational studies of adults resuscitated with ECPR, therapeutic hypothermia was not associated with neurological outcome at hospital discharge in one report (39) and with improved neurological outcome in another (40). Unintentional sustained hypothermia after ECPR has been associated with poor neurological outcome and in-hospital mortality (41).…”

Section: Discussionmentioning

confidence: 96%

Extracorporeal Cardiopulmonary Resuscitation: One-Year Survival and Neurobehavioral Outcome Among Infants and Children With In-Hospital Cardiac Arrest*

Meert

Guerguerian

Barbaro

et al. 2019

Critical Care Medicine

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Objective: To describe neurobehavioral outcomes and investigate factors associated with survival and survival with good neurobehavioral outcome one year after in-hospital cardiac arrest for children who received extracorporeal cardiopulmonary resuscitation (ECPR). Design: Secondary analysis of the Therapeutic Hypothermia after Pediatric Cardiac Arrest In-Hospital (THAPCA-IH) trial. Setting: 37 PICUs in the United States, Canada and the United Kingdom. Patients: Children (n=147) resuscitated with ECPR following in-hospital cardiac arrest.

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Therapeutic Hypothermia May Improve Neurological Outcomes in Extracorporeal Life Support for Adult Cardiac Arrest

Cited by 29 publications

References 22 publications

Targeted temperature management after cardiac arrest: Updated meta-analysis of all-cause mortality and neurological outcomes

Targeted temperature management after cardiac arrest: Updated meta-analysis of all-cause mortality and neurological outcomes

Associations of therapeutic hypothermia with clinical outcomes in patients receiving ECPR after cardiac arrest: systematic review with meta-analysis

Extracorporeal Cardiopulmonary Resuscitation: One-Year Survival and Neurobehavioral Outcome Among Infants and Children With In-Hospital Cardiac Arrest*

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