Hypothermia versus Normothermia after Out-of-Hospital Cardiac Arrest.
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State: Public
Version: author
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Serval ID
serval:BIB_36D6B5C31096
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Hypothermia versus Normothermia after Out-of-Hospital Cardiac Arrest.
Journal
The New England journal of medicine
Working group(s)
TTM2 Trial Investigators
Contributor(s)
Nielsen N., Bělohlávek J., Callaway C., Cariou A., Cronberg T., Dankiewicz J., Eastwood G., Erlinge D., Friberg H., Hovdenes J., Jakobsen J.C., Joannidis M., Kirkegaard H., Levin H., Lilja G., Morgan MPG, Nichol A.D., Nordberg P., Oddo M., Pelosi P., Rylander C., Saxena M., Storm C., Taccone F.S., Ullén S., Wise M.P., Young P.J., Rowan K., Harrison D., Mouncey P., Shankar-Hari M., Young D., Lange T., Palmér K., Bass F., Hammond N., Myburgh J., Taylor C., Bellino A., Abel-All M., Finfer B., Koch C., Li Y., O'Connor A., Pilowsky J., Schneider T., Tippett A., Ady B., Broadley T., Brown A., Melgaard L., Morgan M., Singh V., Symons R., Becker K., Van Sante N., Saleova V., Zerzanova S., Sefir-Kribel S., Lübeck U., Carrara M., Fernando K., Mackle D., Navarra L., Riley J., Westerheim E., Flatebø M., Ceric A., Haxhija Z., Terling L., Bossmar L., Jergle L., Holm Månsson H., Abed Maillard S., Vujicic Zagar A., Jodlauk C., Hill H., Scrivens J., Ainscough K., Fahey C., Bellomo R., Peck L., Young H., Cheung W., Cross R., Hayes M., Jain N., Kol M., Shah A., Wagh A., Wong H., Martinez F.E., Brinkerhoff G., Bush D., Stewart A., Aneman A., Lombardo L., McCanny P., Penketh J., Seppelt I., Gresham R., Lowrey J., Masters K., Whitehead C., Walsham J., Harward M., Mackay J., Meyer J., Saylor E., Venz E., Wetzig K., Stedman W., Ashelford A., Mar S., Tokumitsu M., Yarad E., Buscher H., Reynolds C., Udy A., Bernard S., Burrell A., Collins J., Gantner D., Martin V.E., Mccracken P., Nanjayya V., Nichol A., Richardson A.S., Young M., Ghosh A., Said S., Beer R., Hartig F., Helbok R., Klein S., Peer A., Creteur J., Durand D., Dupont M., Christiaens S., Claes C., Deckx S., Ferdinande B., Lenaerts S., Mullens W., Stroobants S., Theunissen E., Verhaert D., Šmíd O., Flaksa M., Kemlink D., Malík J., Otáhal M., Rulíšek J., Šíranec M., Stach Z., Valeriánová A., Zavadilova P., Králové H., Solař M., Bánszky R., Červená J., Pařízková R.Č., Šimůnek L., Varhaník F., Karásek J., Strýček M., Grejs A., Christensen S., Juhl-Olsen P., Thomsen I.K., Gregersen Østergaard L., Cao A., Dupland P., Gavaud A., Jaubert P., Jozwiak M., Marin N., Savary G., Deye N., Megarbane B., Mora P., Sutterlin L., Legriel S., Bellut H., Ferre A., Lacave G., Paul M., Lascarrou J.B., Canet E., Garret C., Miaihle A.F., Reignier J., Vignon P., Daix T., Desachy A., Evrard B., Francois B., Fedou A.L., Goudelin M., Kress G., Leithner C., Nee J., Streitberger K.J., Brunetti I., Ball L., Battaglini D., Bonatti G., Firpo I., Frisoni P., Iachi A., Maiani S., Mandelli M., Robba C., Tarantino F., Barbieri A., Bertellini E., Giuliani E., Melegari G., Roman-Pognuz E., Berlot G., Lucangelo U., Macchini E., Aune V., Drægni T., Jacobsen S., Pieschke S., Rasmussen Å., Akselsen G.R., Langeland H., Bergum D., Erbe T.M., Klepstad P., Næss H.M., Olsen R.B., Skjelnes L.E., Holen M., Post J.I., Fanebust R., Sørensen L.H., Kårstad K.Å., Wickman C.F., Young P., Barnes C., Barry B., Beehre N., Dinsdale D., Edney S., Hunt A., Judd H., Latimer-Bell C., Lawrence C., Moore J., Olatunji S., Psirides A., Robinson C., Tietjens K., Wright J., Knight D., Birker B., Bowie D., Burke T., Closey D., Crombie R., Davidson N., Henderson S., Hitchings L., McKay J., Mehrtens J., Minto E., Morgan S., Morris A., Ritzemar-Carter J., Roberts J., Shaw G., Townend K., Vander Heyden K., Ahlqvist M., Lindgren R.D., Eiving I., Lundin A., Martner P., Myhrman E., Ryding B., Düring J., Bergström M., Bohm M., Didriksson I., Frid P., Heimburg K., Larsson M., Lundberg O., Olsson Hau S., Schmidbauer S., Borgquist O., Adolfsson A., Bjärnroos A., Blennow-Nordström E., Dragancea I., Kander T., Lybeck A., Mattiasson G., Persson O., Rundgren M., Schrey S., Westhall E., Annborn M., Andertun S., Ebner F., Gustavsson N., Hassel L., Johnsson J., Nelderup M., Petersson H., Petersson J., Stafilidou F., Undén J., Antonsson F., Bergman G., Gamroth J., Meirik M., Rudolfsson K., Sandberg H., Thorsson M., Savolainen K., Hansbo M., Helliksson M., Nödtveidt B., Sanner J., Sem V., Lindquist C.S., Awad A., Börjesson A.S., Hedberg M., Henning M., Hollenberg J., Petersen P., Dahlberg E., Forshammar J., Svensson V., Wanecek M., Eskilsson H., Rodriguez-Santos D., Appelqvist Å., Jidbratt H., Johansson E., Kiszakiewicz L., Nilsson Å., Olsson S., Paulsson A., Stempel U., Thoren A., Persson S., Berglund I., Bergström E., Törnqvist C., Östman I., Rubertsson S., Larsson I.M., Söderman E., Wallin E., Wessbergh J., Halliday T., Engvall F., Ben-Hamouda N., Bernini A., Carron P.N., Eckert P., Favre E., Miroz J.P., Morelli P., Muller O., Novi J., Rosseti A., Schnorf M., Haenggi M., Levis A., Nansoz S., Roth M., Söll N., Schrag C., Alicajic M., Baier P., Dütschler J., Flügel D., Fässler E., Gamio-Veis R., Güpfert M., Hilpertshauser Y., Hägele-Link S., Kleger G.R., Krähenmann P., Mair M.E., Schai N., Strohmaier C., Tangl P., Zieglgänsberger D., Maggiorini M., Claus G., Consani-Vogel G., Imbach L., Kaiser S., Kleinert E.M., Wendel Garcia P.D., Cassina T., Agazzi P., Capelli B., Casso G., Regazzi M., Schlotterbeck H., Via G., Villa M., Brooks J., Cocks E., Cole J., Curtin J., Davies M., Davies R., Fernandez S., Highfield J., Pennant L., Rose S., Thomas E., Williams A., McGuigan P., Haffey S., O'Neill A., Ward K., Thomas M., Bewley J., Chillingworth A., Cloake J., Cole L., Galvin H., Garland Z., Grimmer L., Gumbrill B., Howie L., Johnson R., Searles C., Skorko A., Sweet K., Taylor V., Webster D., Keeble T., Adams G., Aggarwal R.K., Cartwright J.A., Church S., Clesham G.J., Davies J.R., Farrell K., Gamma R., Harding J., Jagathesan R., Kabir A., Kelly P.A., Kittridge L., Maccaroni M., Maloney G., Mion M., Nain N., Nalgirkar R., Namjoshi G., Pepper S., Redman E., Robinson N.M., Sayer J., Solesbury A., Tang K.H., Urovi S., Waghmare K., Watson N., Webber T., Isherwood P., Bentley C., Bergin C., Carrera R., Clark A., Cooper L., Despy L., Dooley N., Ellis K., Fellows E., Goundry S., Harkett S., McGhee C., Neal A., Smith H., Snelson C., Spruce E., Whitehouse T., Yakoub K., Walden A., Bartley S., Bhuie P., Frise M., Jacques N., Keating L., Pogson D., Daly Z., Rose S., Bannard-Smith J., Quayle R., Chee N., Barratt N., Bowman K., Branney D., Howe E., Letts M., Pitts S., Vamplew L., Callaway C.W., Difiore Sprouse S., Doshi A.A., Fugate J., Headlee A.M., Wijdicks EFM
ISSN
1533-4406 (Electronic)
ISSN-L
0028-4793
Publication state
Published
Issued date
17/06/2021
Peer-reviewed
Oui
Volume
384
Number
24
Pages
2283-2294
Language
english
Notes
Publication types: Comparative Study ; Equivalence Trial ; Journal Article ; Multicenter Study ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
Publication Status: ppublish
Publication Status: ppublish
Abstract
Targeted temperature management is recommended for patients after cardiac arrest, but the supporting evidence is of low certainty.
In an open-label trial with blinded assessment of outcomes, we randomly assigned 1900 adults with coma who had had an out-of-hospital cardiac arrest of presumed cardiac or unknown cause to undergo targeted hypothermia at 33°C, followed by controlled rewarming, or targeted normothermia with early treatment of fever (body temperature, ≥37.8°C). The primary outcome was death from any cause at 6 months. Secondary outcomes included functional outcome at 6 months as assessed with the modified Rankin scale. Prespecified subgroups were defined according to sex, age, initial cardiac rhythm, time to return of spontaneous circulation, and presence or absence of shock on admission. Prespecified adverse events were pneumonia, sepsis, bleeding, arrhythmia resulting in hemodynamic compromise, and skin complications related to the temperature management device.
A total of 1850 patients were evaluated for the primary outcome. At 6 months, 465 of 925 patients (50%) in the hypothermia group had died, as compared with 446 of 925 (48%) in the normothermia group (relative risk with hypothermia, 1.04; 95% confidence interval [CI], 0.94 to 1.14; P = 0.37). Of the 1747 patients in whom the functional outcome was assessed, 488 of 881 (55%) in the hypothermia group had moderately severe disability or worse (modified Rankin scale score ≥4), as compared with 479 of 866 (55%) in the normothermia group (relative risk with hypothermia, 1.00; 95% CI, 0.92 to 1.09). Outcomes were consistent in the prespecified subgroups. Arrhythmia resulting in hemodynamic compromise was more common in the hypothermia group than in the normothermia group (24% vs. 17%, P<0.001). The incidence of other adverse events did not differ significantly between the two groups.
In patients with coma after out-of-hospital cardiac arrest, targeted hypothermia did not lead to a lower incidence of death by 6 months than targeted normothermia. (Funded by the Swedish Research Council and others; TTM2 ClinicalTrials.gov number, NCT02908308.).
In an open-label trial with blinded assessment of outcomes, we randomly assigned 1900 adults with coma who had had an out-of-hospital cardiac arrest of presumed cardiac or unknown cause to undergo targeted hypothermia at 33°C, followed by controlled rewarming, or targeted normothermia with early treatment of fever (body temperature, ≥37.8°C). The primary outcome was death from any cause at 6 months. Secondary outcomes included functional outcome at 6 months as assessed with the modified Rankin scale. Prespecified subgroups were defined according to sex, age, initial cardiac rhythm, time to return of spontaneous circulation, and presence or absence of shock on admission. Prespecified adverse events were pneumonia, sepsis, bleeding, arrhythmia resulting in hemodynamic compromise, and skin complications related to the temperature management device.
A total of 1850 patients were evaluated for the primary outcome. At 6 months, 465 of 925 patients (50%) in the hypothermia group had died, as compared with 446 of 925 (48%) in the normothermia group (relative risk with hypothermia, 1.04; 95% confidence interval [CI], 0.94 to 1.14; P = 0.37). Of the 1747 patients in whom the functional outcome was assessed, 488 of 881 (55%) in the hypothermia group had moderately severe disability or worse (modified Rankin scale score ≥4), as compared with 479 of 866 (55%) in the normothermia group (relative risk with hypothermia, 1.00; 95% CI, 0.92 to 1.09). Outcomes were consistent in the prespecified subgroups. Arrhythmia resulting in hemodynamic compromise was more common in the hypothermia group than in the normothermia group (24% vs. 17%, P<0.001). The incidence of other adverse events did not differ significantly between the two groups.
In patients with coma after out-of-hospital cardiac arrest, targeted hypothermia did not lead to a lower incidence of death by 6 months than targeted normothermia. (Funded by the Swedish Research Council and others; TTM2 ClinicalTrials.gov number, NCT02908308.).
Keywords
Aged, Body Temperature, Cardiopulmonary Resuscitation/methods, Coma/etiology, Coma/therapy, Female, Fever/etiology, Fever/therapy, Humans, Hypothermia, Induced/adverse effects, Kaplan-Meier Estimate, Male, Middle Aged, Out-of-Hospital Cardiac Arrest/complications, Out-of-Hospital Cardiac Arrest/mortality, Out-of-Hospital Cardiac Arrest/therapy, Single-Blind Method, Treatment Outcome
Pubmed
Web of science
Create date
28/06/2021 10:24
Last modification date
04/03/2022 6:33
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