Temperature control after adult cardiac arrest: An updated systematic review and meta-analysis

Resuscitation, Journal Year: 2023, Volume and Issue: 191, P. 109928 - 109928

Published: Aug. 7, 2023

To perform an updated systematic review and meta-analysis on temperature control in adult patients with cardiac arrest.The is update of a previous published 2021. An search including PubMed, Embase, the Cochrane Central Register Controlled Trials was performed May 31, 2023. trials humans were included. The population included arrest. all aspects timing, temperature, duration, method induction maintenance, rewarming. Two investigators reviewed for relevance, extracted data, assessed risk bias. Data pooled using random-effects models. Certainty evidence evaluated GRADE.The identified six new trials. Risk bias as intermediate most outcomes. For target 32-34 °C vs. normothermia or 36 °C, two identified, seven meta-analysis. Temperature did not result improvement survival (risk ratio: 1.06 [95%CI: 0.91, 1.23]) favorable neurological outcome 1.27 0.89, 1.81]) at 90-180 days after arrest (low certainty evidence). Subgroup analysis according to location (in-hospital out-of-hospital) found similar results. A sensitivity nine comparing any time point also show outcomes 1.14 [95%CI 0.98, 1.34]). New individual 31-34 12-24 hours hours, rewarming rate 0.25-0.5 °C/hour, effect fever prevention no differences outcomes.This showed benefit compared although 95% confidence intervals cannot rule out potential beneficial effect. Important knowledge gaps exist topics such hypothermic targets, rate, control.

Language: Английский

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Targeted temperature management with hypothermia for comatose patients after cardiac arrest

Clinical and Experimental Emergency Medicine, Journal Year: 2023, Volume and Issue: 10(1), P. 5 - 17

Published: Feb. 16, 2023

Targeted temperature management with mild hypothermia (TTM-hypothermia; 32-34 °C) is a treatment strategy for adult patients who are comatose after cardiac arrest. Robust preclinical data support the beneficial effects of beginning within 4 hours reperfusion and maintained during several days postreperfusion brain dysregulation. TTM-hypothermia increased survival functional recovery arrest in trials realworld implementation studies. also benefits neonates hypoxic-ischemic injury. However, larger methodologically more rigorous do not detect benefit. Reasons inconsistency include difficulty delivering differential between randomized groups use shorter durations treatment. Furthermore, enrolled populations that vary illness severity injury, individual enriched higher or lower severity. There interactions effect. Current indicate implemented quickly arrest, may benefit select at risk severe injury but other patients. More needed on how to identify treatment-responsive titrate timing duration TTM-hypothermia.

Language: Английский

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Implementation of guidelines in clinical practice; barriers and strategies

Current Opinion in Anaesthesiology, Journal Year: 2024, Volume and Issue: 37(2), P. 155 - 162

Published: Jan. 17, 2024

Purpose of review Published clinical practice guidelines frequently have difficulties for implementation the recommendations and adherence in daily practice. The present summarizes current knowledge on barriers encountered when implementing guideline strategies proposed to address these barriers. Recent findings Studies are scarce. Evidence indicates that a multidisciplinary policy is necessary order at various levels. Continuous education motivation stakeholders, together with structural adaptations key elements process. Summary involve different levels, including healthcare system, organizational, societal cultural specificities, individual attitudes. All should be addressed policy-driven strategies. Such could include optimization resources allocations, establishing well coordinated networks, finally, future studies also evaluate effectiveness potential

Language: Английский

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Temperature control after cardiac arrest

Critical Care, Journal Year: 2022, Volume and Issue: 26(1)

Published: Nov. 24, 2022

Abstract Most of the patients who die after cardiac arrest do so because hypoxic-ischemic brain injury (HIBI). Experimental evidence shows that temperature control targeted at hypothermia mitigates HIBI. In 2002, one randomized trial and quasi-randomized showed 32–34 °C improved neurological outcome mortality in are comatose arrest. However, following publication these trials, other studies have questioned neuroprotective effects hypothermia. 2021, largest study conducted far on (the TTM-2 trial) including 1900 adults resuscitation no effect 33 compared with normothermia or fever control. A systematic review 32 trials published between 2001 2021 concluded a target prevention did not result an improvement survival (RR 1.08; 95% CI 0.89–1.30) favorable functional 1.21; 0.91–1.61) 90–180 days resuscitation. There was substantial heterogeneity across certainty low. Based results, International Liaison Committee Resuscitation currently recommends monitoring core actively preventing (37.7 °C) for least 72 h from Future needed to identify potential patient subgroups may benefit aimed comparing

Language: Английский

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Temperature control in adults after cardiac arrest: a survey of current clinical practice in Germany

Critical Care, Journal Year: 2023, Volume and Issue: 27(1)

Published: Jan. 23, 2023

Temperature control is recommended after out of hospital cardiac arrest (OHCA) by international guidelines. This survey aimed to investigate current clinical practice and areas uncertainty.Online targeting members three medical emergency critical care societies in Germany (April 21-June 6, 2022) assessing post-cardiac temperature management.Of 341 completed questionnaires 28% (n = 97) used with normothermic target 72% 244) hypothermic target. The definition fever regarding patients ranged from ≥ 37.7 39.0 °C. was mainly started the ICU (80%, n 273) most commonly core cooling (74%, 254) surface (39%, 134) feedback were used. maintained for 24 h 18% 61), 48 94), 72 42% 143) longer than 13% 43). 7% 24) using different protocols OHCA initial shockable non-shockable rhythm. Additional 14% 48) in-hospital (IHCA) compared OHCA. Overall, 37% 127) changed publication ERC-2021 guidelines 33% 114) recent revised ERC-ESICM guideline on control.One-third respondents since update. However, a majority physicians further trusts Of interest, strategies IHCA A more individualized approach post resuscitation may be warranted.

Language: Английский

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Hypothermia vs Normothermia in Patients With Cardiac Arrest and Nonshockable Rhythm

JAMA Neurology, Journal Year: 2023, Volume and Issue: 81(2), P. 126 - 126

Published: Dec. 18, 2023

International guidelines recommend body temperature control below 37.8 °C in unconscious patients with out-of-hospital cardiac arrest (OHCA); however, a target of 33 might lead to better outcomes when the initial rhythm is nonshockable.

Language: Английский

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Changes Over 7 Years in Temperature Control Treatment and Outcomes After Out-of-Hospital Cardiac Arrest: A Japanese, Multicenter Cohort Study

Therapeutic Hypothermia and Temperature Management, Journal Year: 2024, Volume and Issue: 15(1), P. 23 - 30

Published: Feb. 22, 2024

Temperature control is the only neuroprotective intervention suggested in current international guidelines for patients with return of spontaneous circulation after cardiac arrest, but prevalence temperature therapy, settings, and outcomes have not been clearly reported. We aimed to investigate changes over 7 years provision treatment among out-of-hospital arrest (OHCA) Kanto region, Japan. Data all adult OHCA who survived more than 24 hours prospective cohort studies, SOS-KANTO 2012 (conducted from 2013) 2017 2019 2021), Japan were included. compared proportion mild (≥35°C) moderate (from 32°C 34.9°C) hypothermia between two study groups. also performed a Cox regression analysis evaluate 30-day mortality adjusted by therapy (none, hypothermia, or hypothermia), age, sex, past medical history, witnessed status, bystander cardiopulmonary resuscitation, initial rhythm, location dataset (SOS-KANTO 2017). analyzed data 2936 (n = 1710, 2012; n 1226, Use was lower (45.3% vs. 41.4%, p 0.04), (p < 0.01), higher 0.01) 2012. The survival rate significantly those did receive therapy. Overall, incidence decreased that increased use studies conducted apart area, management might improve OHCA.

Language: Английский

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Detecting awareness after acute brain injury

The Lancet Neurology, Journal Year: 2024, Volume and Issue: 23(8), P. 836 - 844

Published: July 17, 2024

Language: Английский

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Impact of inhaled sedation on delirium incidence and neurological outcome after cardiac arrest – A propensity-matched control study (Isocare)

Resuscitation, Journal Year: 2024, Volume and Issue: 203, P. 110358 - 110358

Published: Aug. 13, 2024

Language: Английский

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Fever Prevention and Neurological Recovery in In-Hospital Cardiac Arrest Survivors at a Limited-Resource Setting

Therapeutic Hypothermia and Temperature Management, Journal Year: 2025, Volume and Issue: unknown

Published: Jan. 15, 2025

Temperature management plays a critical role in the neurological recovery of cardiac arrest survivors. While advanced device-based temperature control systems are prevalent high-resource settings, their implementation low-resource environments remains challenge. This study aimed to examine impact fever prevention on outcomes survivors managed without control. We conducted retrospective adult in-hospital at an academic institution from 2013 2020. Patients were included if they ≥18 years old, survived for least 72 hours post-return spontaneous circulation (ROSC), and experienced inpatient wards, intensive care units, or emergency department. Fever was defined as rectal ≥37.5°C, assessed using Cerebral Performance Category (CPC) scale 1 month post-ROSC. A good outcome CPC 2. Statistical analyses chi-square tests logistic regression identify predictors outcomes. Of 427 patients included, 58.8% fever, 12.8% achieved outcome. with significantly less likely have favorable (p < 0.01). Logistic revealed that each 1°C increase body beyond 37.5°C associated 31% reduction likelihood Other poor prolonged low-flow states higher pre-arrest frailty scores. is strongly survivors, particularly settings management. Effective strategies, such intravenous antipyretics physical cooling methods, should be prioritized improve

Language: Английский

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