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Background: Two randomized controlled trials in 2002 showed that induced hypothermia (32-34°C) had a neuroprotective effect in patients with out-of-hospital cardiac arrest (OHCA) and initial shockable rhythm. This intervention has since been applied to non-shockable rhythms and in-hospital cardiac arrest (IHCA) using a variety of modalities. We performed a systematic review and where applicable, meta-analysis, examining the effect of targeted temperature management (TTM) on mortality and neurological outcome.
Methods: Nine Population, Intervention, Control, Outcome (PICO) questions were developed and searches were conducted using MEDLINE Ovid, EMBASE and Cochrane CENTRAL for publications between January 2000 and February 2016. Studies included were assessed for quality using Cochrane Risk of Bias Tool, National Institute of Health Study Quality Assessment Tools, and Grading of Recommendations Assessment, Development and Evaluation (GRADE).
Results: Low quality evidence shows that TTM at 32-36°C in adults with OHCA and initial shockable rhythm reduces mortality and poor neurological outcome. Very low quality evidence suggests that TTM does not reduce these outcomes in non-shockable OHCA or IHCA. Moderate quality evidence shows that prehospital compared to in-hospital initiation of cooling does not change outcome. Additionally, very low quality evidence suggests that there is no difference in mortality or poor neurological outcome between endovascular and surface cooling methods. However, low quality evidence suggests that cooling methods with feedback control compared to those without reduce poor neurological outcome. Very low quality evidence suggests that cooling duration should be least 18 hours, but there is a paucity of evidence pertaining to optimal cooling and rewarming rates. Highly biased studies suggest presence of fever is not harmful.
Conclusions: Low quality evidence supports the use of TTM, initiated prehospital or in-hospital, at 32-36°C, with a feedback control mechanism, in adults with OHCA and initial shockable rhythm. The effect of TTM on other populations, optimal cooling and rewarming rates, and the effects of fever in OHCA patients require more study.
Poster Hall, Hall C
Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Cardiac Arrest, Diabetes, and Other High Risk Features of Patients With Acute Coronary Syndrome
Abstract Category: 2. Acute and Stable Ischemic Heart Disease: Clinical
Presentation Number: 1204-319
- 2017 American College of Cardiology Foundation