Abdalla Mohammed, Mohamed Abdelnasir, Mohamed Wiam, Khtab Khlwd, Cattoni Hugo, Salih Mohammed
Saint Francis Hospital, Evanston, IL, United States.
University of Khartoum, Sudan.
Int J Cardiol Heart Vasc. 2019 Jul 26;24:100400. doi: 10.1016/j.ijcha.2019.100400. eCollection 2019 Sep.
Cardiac 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.
We conducted a systematic search for randomized controlled trials in Pubmed, Cochrane & ScienceDirect. Primary outcomes were neurological outcome and all-cause mortality.
Nine 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, I = 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, I = 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, I = 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, I = 43.8%, n = 1505).
Targeted temperature management after cardiac arrest may be associated with improvement in all-cause mortality and reduction in poor neurological outcome.
心脏骤停带来了高昂的死亡率和发病率负担。不同研究显示，关于心脏骤停目标温度管理（TTM）的结果存在相互矛盾的数据。本荟萃分析的目的是系统地确定TTM对心脏骤停后全因死亡率和神经学结局的影响。
我们在PubMed、Cochrane和ScienceDirect中对随机对照试验进行了系统检索。主要结局为神经学结局和全因死亡率。
九项利用院内和院外心脏骤停数据的随机对照试验被选入荟萃分析。纳入患者总数为1592例。目标温度管理组的死亡率较低（比值比0.637，95%置信区间0.436 - 0.93，p值0.019，I² = 44.78%，n = 1592）。治疗性低温组在不良神经学结局方面也有降低（比值比0.582，95%置信区间0.363 - 0.931，p值0.024，I² = 56.79%，n = 1567）。在排除院内心脏骤停患者后进行了亚组分析，结果显示院外心脏骤停患者的不良神经学结局有所降低（比值比0.562，95%置信区间0.331 - 0.955，p值0.033，I² = 61.78%，n = 1480）以及死亡率降低（比值比0.674，95%置信区间0.454 - 0.999，p值0.049，I² = 43.8%，n = 1505）。
心脏骤停后的目标温度管理可能与全因死亡率的改善和不良神经学结局的降低有关。
