Systematic review and meta-analysis of intravascular temperature management vs. surface cooling in comatose patients resuscitated from cardiac arrest

Emily S. Bartlett, Terence Valenzuela, Ahamed Idris, Nicolas Deye, Guy Glover, Michael A. Gillies, Fabio S. Taccone, Kjetil Sunde, Alexander C. Flint, Holger Thiele, Jasmin Arrich, Claude Hemphill, Michael Holzer, Markus B. Skrifvars, Undine Pittl, Kees H. Polderman, Marcus E.H. Ong, Ki Hong Kim, Sang Hoon Oh, Sang Do ShinHans Kirkegaard, Graham Nichol

Research output: Contribution to journalReview article

Abstract

Objective: To systematically review the effectiveness and safety of intravascular temperature management (IVTM) vs. 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 vs. SCM were eligible for inclusion. Results: In total, 12 studies met inclusion criteria. These enrolled 1573 patients who received IVTM; and 4008 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 vs. 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
Pages (from-to)82-95
Number of pages14
JournalResuscitation
Volume146
DOIs
StatePublished - 1 Jan 2020

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Coma
Heart Arrest
Meta-Analysis
Temperature
Induced Hypothermia
Out-of-Hospital Cardiac Arrest
Publication Bias
Survival
Emergency Medical Services
Critical Care
PubMed
Resuscitation
Nervous System
Observational Studies
Survivors
Hospital Emergency Service
Cardiac Arrhythmias
Patient Care
Language
Databases

Keywords

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

Cite this

Bartlett, Emily S. ; Valenzuela, Terence ; Idris, Ahamed ; Deye, Nicolas ; Glover, Guy ; Gillies, Michael A. ; Taccone, Fabio S. ; Sunde, Kjetil ; Flint, Alexander C. ; Thiele, Holger ; Arrich, Jasmin ; Hemphill, Claude ; Holzer, Michael ; Skrifvars, Markus B. ; Pittl, Undine ; Polderman, Kees H. ; Ong, Marcus E.H. ; Kim, Ki Hong ; Oh, Sang Hoon ; Do Shin, Sang ; Kirkegaard, Hans ; Nichol, Graham. / Systematic review and meta-analysis of intravascular temperature management vs. surface cooling in comatose patients resuscitated from cardiac arrest. In: Resuscitation. 2020 ; Vol. 146. pp. 82-95.
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abstract = "Objective: To systematically review the effectiveness and safety of intravascular temperature management (IVTM) vs. 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 vs. SCM were eligible for inclusion. Results: In total, 12 studies met inclusion criteria. These enrolled 1573 patients who received IVTM; and 4008 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 vs. 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.",
keywords = "Cardiac arrest, Induced hypothermia, Intravascular temperature management, Surface cooling methods, Targeted temperature management",
author = "Bartlett, {Emily S.} and Terence Valenzuela and Ahamed Idris and Nicolas Deye and Guy Glover and Gillies, {Michael A.} and Taccone, {Fabio S.} and Kjetil Sunde and Flint, {Alexander C.} and Holger Thiele and Jasmin Arrich and Claude Hemphill and Michael Holzer and Skrifvars, {Markus B.} and Undine Pittl and Polderman, {Kees H.} and Ong, {Marcus E.H.} and Kim, {Ki Hong} and Oh, {Sang Hoon} and {Do Shin}, Sang and Hans Kirkegaard and Graham Nichol",
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language = "English",
volume = "146",
pages = "82--95",
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Bartlett, ES, Valenzuela, T, Idris, A, Deye, N, Glover, G, Gillies, MA, Taccone, FS, Sunde, K, Flint, AC, Thiele, H, Arrich, J, Hemphill, C, Holzer, M, Skrifvars, MB, Pittl, U, Polderman, KH, Ong, MEH, Kim, KH, Oh, SH, Do Shin, S, Kirkegaard, H & Nichol, G 2020, 'Systematic review and meta-analysis of intravascular temperature management vs. surface cooling in comatose patients resuscitated from cardiac arrest', Resuscitation, vol. 146, pp. 82-95. https://doi.org/10.1016/j.resuscitation.2019.10.035

Systematic review and meta-analysis of intravascular temperature management vs. surface cooling in comatose patients resuscitated from cardiac arrest. / Bartlett, Emily S.; Valenzuela, Terence; Idris, Ahamed; Deye, Nicolas; Glover, Guy; Gillies, Michael A.; Taccone, Fabio S.; Sunde, Kjetil; Flint, Alexander C.; Thiele, Holger; Arrich, Jasmin; Hemphill, Claude; Holzer, Michael; Skrifvars, Markus B.; Pittl, Undine; Polderman, Kees H.; Ong, Marcus E.H.; Kim, Ki Hong; Oh, Sang Hoon; Do Shin, Sang; Kirkegaard, Hans; Nichol, Graham.

In: Resuscitation, Vol. 146, 01.01.2020, p. 82-95.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Systematic review and meta-analysis of intravascular temperature management vs. surface cooling in comatose patients resuscitated from cardiac arrest

AU - Bartlett, Emily S.

AU - Valenzuela, Terence

AU - Idris, Ahamed

AU - Deye, Nicolas

AU - Glover, Guy

AU - Gillies, Michael A.

AU - Taccone, Fabio S.

AU - Sunde, Kjetil

AU - Flint, Alexander C.

AU - Thiele, Holger

AU - Arrich, Jasmin

AU - Hemphill, Claude

AU - Holzer, Michael

AU - Skrifvars, Markus B.

AU - Pittl, Undine

AU - Polderman, Kees H.

AU - Ong, Marcus E.H.

AU - Kim, Ki Hong

AU - Oh, Sang Hoon

AU - Do Shin, Sang

AU - Kirkegaard, Hans

AU - Nichol, Graham

PY - 2020/1/1

Y1 - 2020/1/1

N2 - Objective: To systematically review the effectiveness and safety of intravascular temperature management (IVTM) vs. 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 vs. SCM were eligible for inclusion. Results: In total, 12 studies met inclusion criteria. These enrolled 1573 patients who received IVTM; and 4008 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 vs. 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.

AB - Objective: To systematically review the effectiveness and safety of intravascular temperature management (IVTM) vs. 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 vs. SCM were eligible for inclusion. Results: In total, 12 studies met inclusion criteria. These enrolled 1573 patients who received IVTM; and 4008 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 vs. 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.

KW - Cardiac arrest

KW - Induced hypothermia

KW - Intravascular temperature management

KW - Surface cooling methods

KW - Targeted temperature management

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U2 - 10.1016/j.resuscitation.2019.10.035

DO - 10.1016/j.resuscitation.2019.10.035

M3 - Review article

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