Mishra Shakti Bedanta, Patnaik Rupali, Rath Arun, Samal Samir, Dash Abhilash, Nayak Biswajit
Department of Critical Care Medicine, IMS and SUM Hospital, Bhubaneswar, Odisha, India.
Indian J Crit Care Med. 2022 Summer;26(4):506-513. doi: 10.5005/jp-journals-10071-24173.
Targeted temperature management (TTM) is a vital element of postresuscitation management after cardiac arrest. Though international guidelines recommend TTM, the supporting evidence is of low certainty.
To estimate the effect of TTM strategy on mortality and neurological outcomes in postcardiac arrest survivors.
Randomized controlled trials (RCTs) published in English evaluating the use of TTM in adult comatose survivors of cardiac arrest were included. Studies were categorized into two groups, based on hypothermia vs normothermia. The main outcome was death due to any origin. The secondary outcome measures evaluated neurological outcome and complications associated with TTM. Outcomes were analyzed by calculating Odds Ratio (OR) of a worse outcome. ORs with 95% CIs in a forest plot were used to show the results of random-effects meta-analyses.
On pooled analysis of 11 RCTs, no difference was observed in death due to any origin rates in the hypothermia compared to the normothermia group (OR; 0.88, 95% CI: 0.39-1.16). Overall, no difference in poor neurological outcome was observed between the two groups (OR; 0.86, 95% CI: 0.66-1.12). Trial sequencing analysis for mortality and poor neurological outcome showed that number to achieve power to predict futility has been achieved in both the parameters.
This meta-analysis showed that hypothermia compared to normothermia TTM strategies does not improve survival or neurologic outcomes.
Mishra SB, Patnaik R, Rath A, Samal S, Dash A, Nayak B. Targeted Temperature Management in Unconscious Survivors of Postcardiac Arrest: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Indian J Crit Care Med 2022;26(4):506-513.
目标温度管理（TTM）是心脏骤停后复苏后管理的重要组成部分。尽管国际指南推荐TTM，但支持证据的确定性较低。
评估TTM策略对心脏骤停后幸存者死亡率和神经功能结局的影响。
纳入以英文发表的评估TTM在成年心脏骤停昏迷幸存者中应用的随机对照试验（RCT）。根据低温与正常体温将研究分为两组。主要结局是任何原因导致的死亡。次要结局指标评估神经功能结局和与TTM相关的并发症。通过计算不良结局的比值比（OR）来分析结局。森林图中带有95%置信区间的OR用于显示随机效应荟萃分析的结果。
对11项RCT进行汇总分析时，与正常体温组相比，低温组任何原因导致的死亡率未观察到差异（OR；0.88，95%置信区间：0.39 - 1.16）。总体而言，两组之间神经功能不良结局未观察到差异（OR；0.86，95%置信区间：0.66 - 1.12）。死亡率和神经功能不良结局的试验序贯分析表明，两个参数均已达到预测无效性的检验效能所需的样本量。
该荟萃分析表明，与正常体温TTM策略相比，低温TTM策略并不能改善生存率或神经功能结局。
Mishra SB, Patnaik R, Rath A, Samal S, Dash A, Nayak B. 心脏骤停后昏迷幸存者的目标温度管理：随机对照试验的系统评价和荟萃分析。《印度重症监护医学杂志》2022；26(4):506 - 513。
