Effect of different methods of cooling for targeted temperature management on outcome after cardiac arrest : a systematic review and meta-analysis

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Calabro , L , Bougouin , W , Cariou , A , De Fazio , C , Skrifvars , M , Soreide , E , Creteur , J , Kirkegaard , H , Legriel , S , Lascarrou , J-B , Megarbane , B , Deye , N & Taccone , F S 2019 , ' Effect of different methods of cooling for targeted temperature management on outcome after cardiac arrest : a systematic review and meta-analysis ' , Critical Care , vol. 23 , no. 1 , 285 . https://doi.org/10.1186/s13054-019-2567-6

Title: Effect of different methods of cooling for targeted temperature management on outcome after cardiac arrest : a systematic review and meta-analysis
Author: Calabro, Lorenzo; Bougouin, Wulfran; Cariou, Alain; De Fazio, Chiara; Skrifvars, Markus; Soreide, Eldar; Creteur, Jacques; Kirkegaard, Hans; Legriel, Stephane; Lascarrou, Jean-Baptiste; Megarbane, Bruno; Deye, Nicolas; Taccone, Fabio Silvio
Contributor: University of Helsinki, HUS Emergency Medicine and Services
Date: 2019-08-23
Language: eng
Number of pages: 12
Belongs to series: Critical Care
ISSN: 1466-609X
URI: http://hdl.handle.net/10138/305482
Abstract: Background Although targeted temperature management (TTM) is recommended in comatose survivors after cardiac arrest (CA), the optimal method to deliver TTM remains unknown. We performed a meta-analysis to evaluate the effects of different TTM methods on survival and neurological outcome after adult CA. Methods We searched on the MEDLINE/PubMed database until 22 February 2019 for comparative studies that evaluated at least two different TTM methods in CA patients. Data were extracted independently by two authors. We used the Newcastle-Ottawa Scale and a modified Cochrane ROB tools for assessing the risk of bias of each study. The primary outcome was the occurrence of unfavorable neurological outcome (UO); secondary outcomes included overall mortality. Results Our search identified 6886 studies; 22 studies (n = 8027 patients) were included in the final analysis. When compared to surface cooling, core methods showed a lower probability of UO (OR 0.85 [95% CIs 0.75-0.96]; p = 0.008) but not mortality (OR 0.88 [95% CIs 0.62-1.25]; p = 0.21). No significant heterogeneity was observed among studies. However, these effects were observed in the analyses of non-RCTs. A significant lower probability of both UO and mortality were observed when invasive TTM methods were compared to non-invasive TTM methods and when temperature feedback devices (TFD) were compared to non-TFD methods. These results were significant particularly in non-RCTs. Conclusions Although existing literature is mostly based on retrospective or prospective studies, specific TTM methods (i.e., core, invasive, and with TFD) were associated with a lower probability of poor neurological outcome when compared to other methods in adult CA survivors (CRD42019111021).
Subject: Targeted temperature management
Methods
Endovascular
Surface cooling
Survival
Neurological outcome
Meta-analysis
THERAPEUTIC HYPOTHERMIA
MILD HYPOTHERMIA
SURFACE
33-DEGREES-C
MULTICENTER
VARIABILITY
INDUCTION
CONSENSUS
TRIAL
3121 General medicine, internal medicine and other clinical medicine
3126 Surgery, anesthesiology, intensive care, radiology
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