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Meta-Analysis
. 2021 Oct:167:160-172.
doi: 10.1016/j.resuscitation.2021.08.040. Epub 2021 Aug 30.

Targeted temperature management in adult cardiac arrest: Systematic review and meta-analysis

Asger Granfeldt  1 , Mathias J Holmberg  2 , Jerry P Nolan  3 , Jasmeet Soar  4 , Lars W Andersen  5 ; International Liaison Committee on Resuscitation (ILCOR) Advanced Life Support Task Force
Affiliations
Free article
Meta-Analysis

Targeted temperature management in adult cardiac arrest: Systematic review and meta-analysis

Asger Granfeldt et al. Resuscitation. 2021 Oct.
Free article

Abstract

Aim: To perform a systematic review and meta-analysis on targeted temperature management in adult cardiac arrest patients.

Methods: PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched on June 17, 2021 for clinical trials. The population included adult patients with cardiac arrest. The review included all aspects of targeted temperature management including timing, temperature, duration, method of induction and maintenance, and rewarming. Two investigators reviewed trials for relevance, extracted data, and assessed risk of bias. Data were pooled using random-effects models. Certainty of evidence was evaluated using GRADE.

Results: The systematic search identified 32 trials. Risk of bias was assessed as intermediate for most of the outcomes. For targeted temperature management with a target of 32-34 °C vs. normothermia (which often required active cooling), 9 trials were identified, with six trials included in meta-analyses. Targeted temperature management with a target of 32-34 °C did not result in an improvement in survival (risk ratio: 1.08 [95%CI: 0.89, 1.30]) or favorable neurologic outcome (risk ratio: 1.21 [95%CI: 0.91, 1.61]) at 90 to 180 days after the cardiac arrest (low certainty of evidence). Three trials assessed different hypothermic temperature targets and found no difference in outcomes (low certainty of evidence). Ten trials were identified comparing prehospital cooling vs. no prehospital cooling with no improvement in survival (risk ratio: 1.01 [95%CI: 0.92, 1.11]) or favorable neurologic outcome (risk ratio: 1.00 [95%CI: 0.90, 1.11]) at hospital discharge (moderate certainty of evidence).

Conclusions: Among adult patients with cardiac arrest, the use of targeted temperature management at 32-34 °C, when compared to normothermia, did not result in improved outcomes in this meta-analysis. There was no effect of initiating targeted temperature management prior to hospital arrival. These findings warrant an update of international cardiac arrest guidelines.

Keywords: Cardiac arrest; Cooling; Hypothermia; Systematic review; Targeted temperature management.

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Conflict of interest statement

Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: None of the authors have any financial conflicts of interests and none of the authors have academic conflicts related to ongoing or planned trials. Lars W. Andersen was compensated in his role as a systematic reviewer by the American Heart Association on behalf of ILCOR for his work related to this systematic review. Jerry Nolan is the editor-in-chief of Resuscitation. Jasmeet Soar is an editor at Resuscitation.

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