Hypothermic versus Normothermic Temperature Control after Cardiac Arrest

Johan Holgersson, Martin Abild Stengaard Meyer, Josef Dankiewicz, Gisela Lilja, Susann Ullén, Christian Hassager, Tobias Cronberg, Matt P. Wise, Jan Bělohlávek, Jan Hovdenes, Paolo Pelosi, David Erlinge, Claudia Schrag, Ondrej Smid, Iole Brunetti, Christian Rylander, Paul J. Young, Manoj Saxena, Anders Åneman, Alain CariouClifton Callaway, Glenn M. Eastwood, Matthias Haenggi, Michael Joannidis, Thomas R. Keeble, Hans Kirkegaard, Christoph Leithner, Helena Levin, Alistair D. Nichol, Matt P. G. Morgan, Per Nordberg, Mauro Oddo, Christian Storm, Fabio Silvio Taccone, Matthew Thomas, John Bro-Jeppesen, Janneke Horn, Jesper Kjaergaard, Michael Kuiper, Tommaso Pellis, Pascal Stammet, Michael Jaeger Wanscher, Hans Friberg, Niklas Nielsen, Janus Christian Jakobsen

Forskningsoutput: TidskriftsbidragArtikel i vetenskaplig tidskriftPeer review


The evidence for temperature control for comatose survivors of cardiac arrest is inconclusive. Controversy exists as to whether the effects of hypothermia differ per the circumstances of the cardiac arrest or patient characteristics.
An individual patient data meta-analysis of the Targeted Temperature Management at 33°C versus 36°C after Cardiac Arrest (TTM) and Hypothermia versus Normothermia after Out-of-Hospital Cardiac Arrest (TTM2) trials was conducted. The intervention was hypothermia at 33°C and the comparator was normothermia. The primary outcome was all-cause mortality at 6 months. Secondary outcomes included poor functional outcome (modified Rankin scale score of 4 to 6) at 6 months. Predefined subgroups based on the design variables in the original trials were tested for interaction with the intervention as follows: age (older or younger than the median), sex (female or male), initial cardiac rhythm (shockable or nonshockable), time to return of spontaneous circulation (above or below the median), and circulatory shock on admission (presence or absence).
The primary analyses included 2800 patients, with 1403 assigned to hypothermia and 1397 to normothermia. Death occurred for 691 of 1398 participants (49.4%) in the hypothermia group and 666 of 1391 participants (47.9%) in the normothermia group (relative risk with hypothermia, 1.03; 95% confidence interval [CI], 0.96 to 1.11; P=0.41). A poor functional outcome occurred for 733 of 1350 participants (54.3%) in the hypothermia group and 718 of 1330 participants (54.0%) in the normothermia group (relative risk with hypothermia, 1.01; 95% CI, 0.94 to 1.08; P=0.88). Outcomes were consistent in the predefined subgroups.
Hypothermia at 33°C did not decrease 6-month mortality compared with normothermia after out-of-hospital cardiac arrest. (Funded by Vetenskapsrådet; ClinicalTrials.gov numbers NCT02908308 and NCT01020916.)
Sidor (från-till)1-13
TidskriftNEJM Evidence
StatusPublished - 2022

Ämnesklassifikation (UKÄ)

  • Kardiologi


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