Abstract
Routine targeted temperature management is recommended for comatose adult patients with return of spontaneous circulation after cardiac arrest. However, the role of targeted temperature management in patients resuscitated from nonshockable cardiac arrests remains uncertain. We conducted an updated systematic review and meta-analysis to evaluate the effects of targeted temperature management in this population. Medline, EMBASE, and Cochrane databases were systematically reviewed for studies published between January 2005 and March 2016, in which targeted temperature management was compared with standard care or normothermia for adult patients resuscitated from nonshockable cardiac arrests. A total of 25 trials that included 5715 patients were identified from 10985 relevant papers. Pooled data showed that targeted temperature management not only associated with improved short-term survival (RR = 1.42, 95% CI: 1.28–1.57) and neurological function (RR = 1.63, 95% CI: 1.39–1.91) but also associated with improved long-term survival (RR = 1.64, 95% CI: 1.27–2.12) and neurological recovery (RR = 1.42, 95% CI: 1.07–1.90) in observational cohort studies. However, more frequent infectious complications were reported in hypothermia-treated patients (RR = 1.46, 95% CI: 1.26–1.70) and the quality of the evidence ranged from moderate to very low.
Highlights
With an incidence ranging from 35 to 125 cases per 100,000 people, out-of-hospital cardiac arrest (OHCA) remains a major public health problem all over the world [1]
EMBASE, and Cochrane databases were systematically reviewed for studies published between January 2005 and March 2016, in which temperature management (TTM) was compared with standard care or normothermia for adult patients resuscitated from nonshockable cardiac arrests
In a previous meta-analysis, Kim et al [11] examined the evidence for beneficial effects of TTM in patients who experienced nonshockable cardiac arrests using pooled data from 2 randomized controlled trials (RCTs) and 12 observational cohort studies (OCSs) and concluded that TTM was associated with reduced in-hospital mortality (RR = 0.84, 95% confidence interval (CI): 0.78–0.92)
Summary
With an incidence ranging from 35 to 125 cases per 100,000 people, out-of-hospital cardiac arrest (OHCA) remains a major public health problem all over the world [1]. Epidemiologic trends suggest that the incidence of OHCA with initial nonshockable rhythms has been growing during the last two decades [4], and the prognosis of such OHCAs is poor, with a survival rate less than 5% [5]. Earlier randomized trials demonstrated that targeted temperature management (TTM) improves cerebral recovery [7, 8]. Routine TTM is strongly recommended for comatose adult patients with return of spontaneous circulation (ROSC) after cardiac arrest [10]. For patients with shockable rhythms, the evidence is based on randomized controlled trials (RCTs). For patients with nonshockable rhythms, the benefits of TTM remain conflicting and the recommendation is based on consensus of expert opinion [10]
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