Systematic Review and Meta-Analysis of INTRAvascular Temperature Management versus Surface Cooling in COMATose Patients Resuscitated from Cardiac Arrest

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaperReviewResearchpeer-review

  • Emily Bartlett, Department of Emergency Medicine, University of Washington, Seattle, Washington, United States of America. Electronic address: emilysb2@uw.edu.
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  • Terence Valenzuela, Department of Emergency Medicine, University of Arizona, Tucson, Arizona, United States of America; Tucson Fire Department, Tucson, Arizona, United States of America.
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  • Ahamed Idris, Departments of Emergency and Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America.
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  • Nicolas Deye, Medical Intensive Care Unit, Inserm U942, Lariboisiere Hospital, APHP, F-75019, Paris, France.
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  • Guy Glover, Department of Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
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  • Michael Gillies, Department of Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
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  • Fabio Silvio Taccone, Department of Intensive Care, Cliniques Universitaires de Bruxelles Hopital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium.
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  • Kjetil Sunde, Department of Anaesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
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  • Alexander Flint, Divison of Research, Kaiser Permanente, Oakland, California, United States; Neuroscience Department, Kaiser Permanente, Redwood City, California, United States.
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  • Holger Thiele, Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany.
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  • Jasmin Arrich, Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria; Center of Emergency Medicine, University of Jena, Faculty of Medicine, Jena, Germany.
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  • Claude Hemphill, Department of Neurology, University of California, San Francisco, California, United States.
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  • Michael Holzer, Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria.
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  • Markus B Skrifvars, Department of Emergency Care and Services, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
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  • Undine Pittl, Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany.
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  • Kees Polderman, Essex Cardiothoracic Centre, Basildon, Essex, SS16 5NL, United Kingdom; Anglia Ruskin School of Medicine, Chelmsford, CM1 1SQ, United Kingdom.
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  • Marcus Eh Ong, Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore; Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore.
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  • Ki Hong Kim, Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
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  • Sang Hoon Oh, Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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  • Sang Shin, Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea.
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  • Hans Kirkegaard
  • Graham Nichol, Department of Emergency Medicine, University of Washington, Seattle, Washington, United States of America; Department of Internal Medicine, University of Washington, Seattle, Washington, United States of America; University of Washington-Harborview Center for Prehospital Emergency Care, Seattle, Washington, United States of America.

OBJECTIVE: To systematically review the effectiveness and safety of intravascular temperature management (IVTM) versus surface cooling methods (SCM) for induced hypothermia (IH).

METHODS: Systematic review and meta-analysis. English-language PubMed, Embase and the Cochrane Database of Systematic Reviews were searched on May 27, 2019. The quality of included observational studies was graded using the Newcastle-Ottawa Quality Assessment tool. The quality of included randomized trials was evaluated using the Cochrane Collaboration's risk of bias tool. Random effects modeling was used to calculate risk differences for each outcome. Statistical heterogeneity and publication bias were assessed using standard methods.

ELIGIBILITY: Observational or randomized studies comparing survival and/or neurologic outcomes in adults aged 18 years or greater resuscitated from out-of-hospital cardiac arrest receiving IH via IVTM versus SCM were eligible for inclusion.

RESULTS: In total, 12 studies met inclusion criteria. These enrolled 1,573 patients who received IVTM; and 4,008 who received SCM. Survival was 55.0% in the IVTM group and 51.2% in the SCM group [pooled risk difference 2% (95% CI -1%, 5%)]. Good neurological outcome was achieved in 40.9% in the IVTM and 29.5% in the surface group [pooled risk difference 5% (95% CI 2%, 8%)]. There was a 6% (95% CI 11%, 2%) lower risk of arrhythmia with use of IVTM and 15% (95% CI 22%, 7%) decreased risk of overcooling with use of IVTM versus SCM. There was no significant difference in other evaluated adverse events between groups.

CONCLUSIONS: IVTM was associated with improved neurological outcomes vs. SCM among survivors resuscitated following cardiac arrest. These results may have implications for care of patients in the emergency department and intensive care settings after resuscitation from cardiac arrest.

Original languageEnglish
JournalResuscitation
Volume146
Pages (from-to)82-95
Number of pages13
ISSN0300-9572
DOIs
Publication statusPublished - Jan 2020

    Research areas

  • Cardiac arrest, Induced hypothermia, Intravascular temperature management, Surface cooling methods, Targeted temperature management

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