Hypothermia versus Normothermia after Out-of-Hospital Cardiac Arrest

Autor: Dankiewicz J., Cronberg T., Lilja G., Jakobsen J. C., Levin H., Ullen S., Rylander C., Wise M. P., Oddo M., Cariou A., Belohlavek J., Hovdenes J., Saxena M., Kirkegaard H., Young P. J., Pelosi P., Storm C., Taccone F. S., Joannidis M., Callaway C., Eastwood G. M., Morgan M. P. G., Nordberg P., Erlinge D., Nichol A. D., Chew M. S., Hollenberg J., Thomas M., Bewley J., Sweet K., Grejs A. M., Christensen S., Haenggi M., Levis A., Lundin A., During J., Schmidbauer S., Keeble T. R., Karamasis G. V., Schrag C., Faessler E., Smid O., Otahal M., Maggiorini M., Wendel Garcia P. D., Jaubert P., Cole J. M., Solar M., Borgquist O., Leithner C., Abed-Maillard S., Navarra L., Annborn M., Unden J., Brunetti I., Awad A., McGuigan P., Olsen R. B., Cassina T., Vignon P., Langeland H., Lange T., Friberg H., Nielsen N. Collaborators, Erik Roman Pognuz, Umberto Lucangelo, Giorgio Berlot, Elisabetta Macchini.
Přispěvatelé: Dankiewicz, J., Cronberg, T., Lilja, G., Jakobsen, J. C., Levin, H., Ullen, S., Rylander, C., Wise, M. P., Oddo, M., Cariou, A., Belohlavek, J., Hovdenes, J., Saxena, M., Kirkegaard, H., Young, P. J., Pelosi, P., Storm, C., Taccone, F. S., Joannidis, M., Callaway, C., Eastwood, G. M., Morgan, M. P. G., Nordberg, P., Erlinge, D., Nichol, A. D., Chew, M. S., Hollenberg, J., Thomas, M., Bewley, J., Sweet, K., Grejs, A. M., Christensen, S., Haenggi, M., Levis, A., Lundin, A., During, J., Schmidbauer, S., Keeble, T. R., Karamasis, G. V., Schrag, C., Faessler, E., Smid, O., Otahal, M., Maggiorini, M., Wendel Garcia, P. D., Jaubert, P., Cole, J. M., Solar, M., Borgquist, O., Leithner, C., Abed-Maillard, S., Navarra, L., Annborn, M., Unden, J., Brunetti, I., Awad, A., Mcguigan, P., Olsen, R. B., Cassina, T., Vignon, P., Langeland, H., Lange, T., Friberg, H., Collaborators:, Nielsen N., ROMAN-POGNUZ, Erik, Lucangelo, Umberto, Berlot, Giorgio, Macchini, Elisabetta
Rok vydání: 2021
Předmět:
Male
Fever
Heart disease
medicine.medical_treatment
Coma/etiology
Hypothermia
Kaplan-Meier Estimate
Targeted temperature management
GUIDELINES
Out of hospital cardiac arrest
Body Temperature
law.invention
TARGETED TEMPERATURE MANAGEMENT
Randomized controlled trial
Hypothermia
Induced
law
AMERICAN-HEART-ASSOCIATION
EUROPEAN RESUSCITATION COUNCIL
medicine
Humans
Single-Blind Method
Cardiopulmonary resuscitation
Coma
610 Medicine & health
Aged
Cardiopulmonary Resuscitation
Female
Middle Aged
Out-of-Hospital Cardiac Arrest
Treatment Outcome
business.industry
Induced
General Medicine
medicine.disease
Out-of-Hospital Cardiac Arrest/complications
Fever/etiology
Clinical research
Hypothermia
Induced/adverse effects
CARDIOPULMONARY-RESUSCITATION
Anesthesia
Cardiopulmonary Resuscitation/methods
medicine.symptom
business
Human
Zdroj: Dankiewicz, J, Cronberg, T, Lilja, G, Jakobsen, J C, Levin, H, Ullen, S, Rylander, C, Wise, M P, Oddo, M, Cariou, A, Belohlavek, J, Hovdenes, J, Saxena, M, Kirkegaard, H, Young, P J, Pelosi, P, Storm, C, Taccone, F S, Joannidis, M, Callaway, C, Eastwood, G M, Morgan, M P G, Nordberg, P, Erlinge, D, Nichol, A D, Chew, M S, Hollenberg, J, Thomas, M, Bewley, J, Sweet, K, Grejs, A M, Christensen, S, Haenggi, M, Levis, A, Lundin, A, During, J, Schmidbauer, S, Keeble, T R, Karamasis, G V, Schrag, C, Faessler, E, Smid, O, Otahal, M, Maggiorini, M, Wendel Garcia, P D, Jaubert, P, Cole, J M, Solar, M, Lange, T, Nielsen, N & TTM2 Trial Invest 2021, ' Hypothermia versus Normothermia after Out-of-Hospital Cardiac Arrest ', New England Journal of Medicine, vol. 384, no. 24, pp. 2283-2294 . https://doi.org/10.1056/NEJMoa2100591
Lange, T & TTM2 Trial Investigators 2021, ' Hypothermia versus Normothermia after Out-of-Hospital Cardiac Arrest ', The New England Journal of Medicine, vol. 384, no. 24, pp. 2283-2294 . https://doi.org/10.1056/NEJMoa2100591
ISSN: 1533-4406
0028-4793
DOI: 10.1056/nejmoa2100591
Popis: Hypothermia or Normothermia after Cardiac ArrestThis trial randomly assigned patients with coma after out-of-hospital cardiac arrest to undergo targeted hypothermia at 33 degrees C or normothermia with treatment of fever. At 6 months, there were no significant between-group differences regarding death or functional outcomes.BackgroundTargeted temperature management is recommended for patients after cardiac arrest, but the supporting evidence is of low certainty.MethodsIn 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 degrees C, followed by controlled rewarming, or targeted normothermia with early treatment of fever (body temperature, >= 37.8 degrees 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.ResultsA 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%, PConclusionsIn 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, .)
Databáze: OpenAIRE
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