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. 2016 Mar 15;3(3):CD010570.
doi: 10.1002/14651858.CD010570.pub2.

Pre-hospital versus in-hospital initiation of cooling for survival and neuroprotection after out-of-hospital cardiac arrest

Jasmin Arrich  1 , Michael Holzer, Christof Havel, Alexandra-Maria Warenits, Harald Herkner
Affiliations

Pre-hospital versus in-hospital initiation of cooling for survival and neuroprotection after out-of-hospital cardiac arrest

Jasmin Arrich et al. Cochrane Database Syst Rev. .

Abstract

Background: Targeted temperature management (also known under 'therapeutic hypothermia', 'induced hypothermia'", or 'cooling') has been shown to be beneficial for neurological outcome in patients who have had successful resuscitation from sudden cardiac arrest, but it remains unclear when this intervention should be initiated.

Objectives: To assess the effects of pre-hospital initiation of cooling on survival and neurological outcome in comparison to in-hospital initiation of cooling for adults with pre-hospital cardiac arrest.

Search methods: We searched CENTRAL, MEDLINE, EMBASE, CINAHL, BIOSIS, and three trials registers from inception to 5 March 2015, and carried out reference checking, citation searching, and contact with study authors to identify additional studies.

Selection criteria: We searched for randomized controlled trials (RCTs) in adults with out-of-hospital cardiac arrest comparing cooling in the pre-hospital setting to in-hospital cooling. Our primary outcomes were survival and neurological outcome; our secondary outcomes were adverse events, quality of life, and length of stay in the intensive care unit (ICU) and in the hospital.

Data collection and analysis: We used Cochrane's standard methodological procedures.

Main results: We included seven RCTs (2369 participants randomized) on the induction of pre-hospital cooling in comparison to in-hospital cooling. There was considerable methodological heterogeneity and risk of bias mainly due to deficits in the administration of cooling, therefore we refrained from pooling the results for survival and neurological outcome and we presented the results for each study separately. Adverse events were rare: based on four studies with 1713 adults pre-hospital induction of cooling may increase the risk of cardiac re-arrests. Risk of bias within the seven individual studies was generally moderate. Overall the quality of the evidence was very low. This was mainly driven by inconsistency and low precision.

Authors' conclusions: Currently, there is no convincing evidence to clearly delineate beneficial or harmful effects of pre-hospital induction of cooling in comparison to in-hospital induction of cooling. This conclusion is based on very low quality evidence.

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Conflict of interest statement

Jasmin Arrich has no conflict of interest.

Michael Holzer received travel grants for scientific conferences and honoraria for lectures from Bard Medical, EmCools, Polimed Sp. z o.o. and Zoll Medical Österreich. He also received honoraria for consulting from Zoll Medical Österreich and was responsible for studies where the Department of Emergency Medicine received study grants from Velomedix and Philips.

Michael Holzer and Christof Havel were involved in the design, conduct, and publication of the HACA 2002 trial.

Alexandra‐Maria Warenits has no conflict of interest

Harald Herkner has no conflict of interest.

Figures

1
1
Study flow diagram.
2
2
'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
4
4
Forest plot of comparison: 2 Survival: pre‐hospital cooling versus in‐hospital cooling, outcome: 2.1 Survival.
5
5
Forest plot of comparison: 1 Neurological outcome: pre‐hospital cooling versus in‐hospital cooling, outcome: 1.1 Good neurological outcome.
1.1
1.1. Analysis
Comparison 1 Survival: pre‐hospital cooling versus in‐hospital cooling, Outcome 1 Survival.
2.1
2.1. Analysis
Comparison 2 Neurological outcome: pre‐hospital cooling versus in‐hospital cooling, Outcome 1 Good neurological outcome.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

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References to other published versions of this review

Arrich 2013
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