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Intravascular vs. surface cooling in out-of-hospital cardiac arrest patients receiving hypothermia after hospital arrival: a post hoc analysis of the TTM2 trial
A. Awad, M. Jonsson, J. Holgersson, JC. Jakobsen, J. Hollenberg, M. Thomas, PDW. Garcia, M. Ringh, AM. Grejs, TR. Keeble, J. Bělohlávek, A. Cariou, F. Annoni, G. Lilja, FS. Taccone, C. Rylander, N. Nielsen, J. Dankiewicz, P. Nordberg
Language English Country United States
Document type Journal Article, Randomized Controlled Trial, Comparative Study
Grant support
20210394
Hjärt-Lungfonden
- MeSH
- Cardiopulmonary Resuscitation methods MeSH
- Middle Aged MeSH
- Humans MeSH
- Aged MeSH
- Hypothermia, Induced * methods MeSH
- Treatment Outcome MeSH
- Out-of-Hospital Cardiac Arrest * therapy mortality MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Randomized Controlled Trial MeSH
- Comparative Study MeSH
PURPOSE: To compare the performance of targeted temperature management (TTM) at 33 °C using intravascular (IC) vs. surface-cooling (SFC) devices after out-of-hospital cardiac arrest (OHCA). METHODS: A post hoc analysis including OHCA patients randomized to hypothermia in the TTM2-trial (NCT02908308) comparing hypothermia with normothermia. The main outcome was cooling performance, defined as the proportion of patients reaching target temperature < 33.5 °C within 4 h, time outside temperature ranges during maintenance, rewarming rate and post-TTM fever. Exploratory outcomes included survival and good functional outcome, defined as modified Rankin Scale (mRS) scores of 0-3 at 6 months, analyzed using Inverse Probability Treatment Weighting (IPTW). RESULTS: Among 930 patients randomized to hypothermia, 876 were treated with a cooling device and included in this study. Of those, 27.3% received IC devices, while 72.7% received SFC devices. The proportion reaching target temperature within 4 h was higher with IC (IC: 69.6% vs. SFC: 49.2%; p < 0.001). Temperature outside ranges during the cooling period and post-TTM fever were lower with IC compared to SFC (17.2% vs. 39.6%; p < 0.001 and 0% vs. 6.3%; p < 0.001, respectively). In the exploratory IPTW analysis, 6-month survival rates were 55.2% in the IC group and 50.2% in the SFC group (OR 1.22, 95% CI 0.89-1.68) and survival with good functional outcome at 6 months was 51.1% patients in the IC group and 44.9% in the SFC (OR 1.28, 95% CI 0.93-1.77). CONCLUSIONS: Among OHCA patients randomized to hypothermia in the TTM2 study, intravascular cooling, compared with surface cooling, was associated with better cooling performance.
Anesthesiology and Intensive Care Department of Clinical Sciences Lund Lund University Lund Sweden
Anesthesiology and Intensive Care Department of Surgical Sciences Uppsala University Uppsala Sweden
Cochin University Hospital Paris France
Department of Clinical Medicine Aarhus University Aarhus Denmark
Department of Clinical Sciences Cardiology Lund University Skåne University Hospital Lund Sweden
Department of Intensive Care Erasme Hospital Université Libre de Bruxelles Brussels Belgium
Department of Intensive Care Medicine Aarhus University Hospital Aarhus Denmark
Department of Neurology Skane University Hospital Lund Sweden
Department of Physiology and Pharcmacology Karolinska Institute Stockholm Sweden
Essex Cardio Thoracic Centre Basildon Essex UK Thurrock University Hospitals Basildon UK
Institute of Heart Diseases Wroclaw Medical University Wroclaw Poland
Neurology Department of Clinical Sciences Lund Lund University Lund Sweden
University Hospitals Bristol NHS Foundation Trust Bristol UK
References provided by Crossref.org
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- $a PURPOSE: To compare the performance of targeted temperature management (TTM) at 33 °C using intravascular (IC) vs. surface-cooling (SFC) devices after out-of-hospital cardiac arrest (OHCA). METHODS: A post hoc analysis including OHCA patients randomized to hypothermia in the TTM2-trial (NCT02908308) comparing hypothermia with normothermia. The main outcome was cooling performance, defined as the proportion of patients reaching target temperature < 33.5 °C within 4 h, time outside temperature ranges during maintenance, rewarming rate and post-TTM fever. Exploratory outcomes included survival and good functional outcome, defined as modified Rankin Scale (mRS) scores of 0-3 at 6 months, analyzed using Inverse Probability Treatment Weighting (IPTW). RESULTS: Among 930 patients randomized to hypothermia, 876 were treated with a cooling device and included in this study. Of those, 27.3% received IC devices, while 72.7% received SFC devices. The proportion reaching target temperature within 4 h was higher with IC (IC: 69.6% vs. SFC: 49.2%; p < 0.001). Temperature outside ranges during the cooling period and post-TTM fever were lower with IC compared to SFC (17.2% vs. 39.6%; p < 0.001 and 0% vs. 6.3%; p < 0.001, respectively). In the exploratory IPTW analysis, 6-month survival rates were 55.2% in the IC group and 50.2% in the SFC group (OR 1.22, 95% CI 0.89-1.68) and survival with good functional outcome at 6 months was 51.1% patients in the IC group and 44.9% in the SFC (OR 1.28, 95% CI 0.93-1.77). CONCLUSIONS: Among OHCA patients randomized to hypothermia in the TTM2 study, intravascular cooling, compared with surface cooling, was associated with better cooling performance.
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