Hypothermia versus Normothermia after Out-of-Hospital Cardiac Arrest

Dankiewicz, Josef and Cronberg, Tobias and Lilja, Gisela and Jakobsen, Janus C. and Levin, Helena and Ullén, Susann and Rylander, Christian and Wise, Matt P. and Oddo, Mauro and Cariou, Alain and Bělohlávek, Jan and Hovdenes, Jan and Saxena, Manoj and Kirkegaard, Hans and Young, Paul J. and Pelosi, Paolo and Storm, Christian and Taccone, Fabio S. and Joannidis, Michael and Callaway, Clifton and Eastwood, Glenn M. and Morgan, Matt P. G. and Nordberg, Per and Erlinge, David and Nichol, Alistair D. and Chew, Michelle S. and Hollenberg, Jacob and Thomas, Matthew and Bewley, Jeremy and Sweet, Katie and Grejs, Anders M. and Christensen, Steffen and Haenggi, Matthias and Levis, Anja and Lundin, Andreas and Düring, Joachim and Schmidbauer, Simon and Keeble, Thomas R. and Karamasis, Grigoris V. and Schrag, Claudia and Faessler, Edith and Smid, Ondrej and Otáhal, Michal and Maggiorini, Marco and Wendel Garcia, Pedro D. and Jaubert, Paul and Cole, Jade M. and Solar, Miroslav and Borgquist, Ola and Leithner, Christoph and Abed-Maillard, Samia and Navarra, Leanlove and Annborn, Martin and Undén, Johan and Brunetti, Iole and Awad, Akil and McGuigan, Peter and Bjørkholt Olsen, Roy and Cassina, Tiziano and Vignon, Philippe and Langeland, Halvor and Lange, Theis and Friberg, Hans and Nielsen, Niklas (2021) Hypothermia versus Normothermia after Out-of-Hospital Cardiac Arrest. New England Journal of Medicine, 384 (24). pp. 2283-2294. ISSN 1533-4406

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Official URL: https://doi.org/10.1056/NEJMoa2100591

Abstract

Background- Targeted temperature management is recommended for patients after cardiac arrest, but the supporting evidence is of low certainty. Methods- 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. Results- 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. Conclusions- 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. opens in new tab.)

Item Type: Journal Article
Faculty: Faculty of Health, Education, Medicine & Social Care
Depositing User: Lisa Blanshard
Date Deposited: 01 Sep 2021 12:58
Last Modified: 17 Sep 2021 14:53
URI: https://arro.anglia.ac.uk/id/eprint/706889

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