Targeted temperature management after cardiac arrest: Updated meta-analysis of all-cause mortality and neurological outcomes

Abstract

BackgroundCardiac arrest carries high mortality and morbidity burden. Different studies showed conflicting data regarding outcomes of targeted temperature management (TTM) for cardiac arrest. The purpose of this meta-analysis is to systematically determine the effect of TTM on all-cause mortality and neurological outcomes after cardiac arrest. MethodsWe conducted a systematic search for randomized controlled trials in Pubmed, Cochrane & ScienceDirect. Primary outcomes were neurological outcome and all-cause mortality. ResultsNine randomized controlled trials utilizing data for in-hospital and out-of-hospital cardiac arrest were selected for meta-analysis. Total number of patients included was 1592. Mortality was lower in targeted temperature management group (OR 0.637, 95% CI 0.436–0.93, p-value 0.019, I2 = 44.78%, n = 1592). Therapeutic hypothermia group also demonstrated reduction in poor neurological outcomes (OR 0.582, 95% CI 0.363–931, p-value 0.024, I2 = 56.79%, n = 1567). Subgroup analysis was conducted, after excluding in-hospital cardiac arrest patients, and demonstrated reduction in poor neurological outcome (OR 0.562, 95% CI 0.331–0.955, p-value 0.033, I2 = 61.78%, n = 1480) and mortality in out-of-hospital cardiac arrest patients (OR 0.674, 95% CI 0.454–999, p-value 0.049, I2 = 43.8%, n = 1505). ConclusionTargeted temperature management after cardiac arrest may be associated with improvement in all-cause mortality and reduction in poor neurological outcome.