Effect of cooling methods and target temperature on outcomes in comatose patients resuscitated from cardiac arrest: Systematic review and network meta-analysis of randomized trials

Shingo Matsumoto, Toshiki Kuno, Takahisa Mikami, Hisato Takagi, Takanori Ikeda, Alexandros Briasoulis, Anna E. Bortnick, Daniel Sims, Jason N. Katz, Jacob Jentzer, Sripal Bangalore, Carlos L. Alviar

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Targeted temperature management (TTM) has been recommended after cardiac arrest (CA), however the specific temperature targets and cooling methods (intravascular cooling (IVC) versus surface cooling (SC)) remain uncertain. Methods: PUBMED and EMBASE were searched until October 8, 2022 for randomized clinical trials (RCTs) investigating the efficacy of TTM after CA. The randomized treatment arms were categorized into the following 6 groups: 31.C to 33.C IVC, 31.C to 33.C SC, 34.C to 36.C IVC, 34.C to 36.C SC, strict normothermia or fever prevention (Strict NT or FP), and standard of care without TTM (No-TTM). The primary outcome was neurological recovery. P-score was used to rank the treatments, where a larger value indicates better performance. Results: We identified 15 RCTs, involving 5,218 patients with CA. Compared to No-TTM as the reference, the other therapeutic options significantly improved neurological outcomes (vs No-TTM; 31.C to 33.C IVC: RR = 0.67, 95% CI 0.54 to 0.83; 31.C to 33.C SC RR = 0.73, 95% CI 0.61 to 0.87; 34.C to 36.C IVC: RR = 0.66, 95% CI 0.51 to 0.86; 34.C to 36.C SC: RR = 0.73, 0.59 to 0.90; Strict NT or FP: RR = 0.75, 95% CI 0.62 to 0.90). Overall, 31-33.C IVC had the highest probability to be the best therapeutic option to improve outcomes (the ranking P-score of 0.836). As a subgroup analysis, the ranking P-score showed that IVC might be a better cooling method compared to SC (IVC vs SC P-score: 0.960 vs 0.670). Conclusions: Hypothermia (31.C to 36.C IVC and SC) and active normothermia (Strict-NT and Strict-FP) were associated with better neurological outcomes compared to No-TTM, with IVC having a greater probability of being the better cooling method than SC.

Original languageEnglish (US)
Pages (from-to)73-84
Number of pages12
JournalAmerican heart journal
Volume256
DOIs
StatePublished - Feb 2023

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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