Hypothermia vs Normothermia in Patients With Cardiac Arrest and Nonshockable Rhythm - Archive ouverte HAL
Article Dans Une Revue JAMA neurology Année : 2023

Hypothermia vs Normothermia in Patients With Cardiac Arrest and Nonshockable Rhythm

1 ULB - Université libre de Bruxelles
2 Lund University
3 Skane University Hospital [Lund]
4 AfterROSC - After ROSC research network [Paris, France]
5 Hôpital Cochin [AP-HP]
6 CHU Angers - Centre Hospitalier Universitaire d'Angers
7 UK - Univerzita Karlova [Praha, Česká republika] = Charles University [Prague, Czech Republic]
8 CHRO - Centre Hospitalier Régional d'Orléans
9 CHD Vendée - Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon
10 CIC 1402 - CIC Poitiers – Centre d'investigation clinique de Poitiers
11 Aarhus University Hospital
12 Aarhus University [Aarhus]
13 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Pontchaillou]
14 CHRU Lille - Centre Hospitalier Régional Universitaire [CHU Lille]
15 Inselspital - Bern University Hospital [Berne]
16 UNIBE - Universität Bern = University of Bern = Université de Berne
17 Oslo University Hospital [Oslo]
18 Copenhagen University Hospital
19 SDU - University of Southern Denmark
20 UNISTRA - Université de Strasbourg
21 NanoRegMed - Nanomédecine Régénérative
22 HUS - Les Hôpitaux Universitaires de Strasbourg
23 HUB-ULB - Hôpital Erasme = Erasmus Hospital = Erasmus Ziekenhuis
24 UniGe - Università degli studi di Genova = University of Genoa
25 Uppsala University Hospital
26 GIGH - The George Institute for Global Health [Sydney]
27 Southmead Hospital
28 Malaghan Institute of Medical Research [Wellington, New Zealand]
29 Monash University [Melbourne]
30 UHW - University Hospital of Wales
31 CHU Nantes - Centre Hospitalier Universitaire de Nantes = Nantes University Hospital
32 MIP - Motricité, interactions, performance UR 4334 / Movement - Interactions - Performance
Matt Thomas
  • Fonction : Auteur

Résumé

Importance: International guidelines recommend body temperature control below 37.8 °C in unconscious patients with out-of-hospital cardiac arrest (OHCA); however, a target temperature of 33 °C might lead to better outcomes when the initial rhythm is nonshockable.
Objective: To assess whether hypothermia at 33 °C increases survival and improves function when compared with controlled normothermia in unconscious adults resuscitated from OHCA with initial nonshockable rhythm.
Data Sources: Individual patient data meta-analysis of 2 multicenter, randomized clinical trials (Targeted Normothermia after Out-of-Hospital Cardiac Arrest [TTM2; NCT02908308] and HYPERION [NCT01994772]) with blinded outcome assessors. Unconscious patients with OHCA and an initial nonshockable rhythm were eligible for the final analysis.
Study Selection: The study cohorts had similar inclusion and exclusion criteria. Patients were randomized to hypothermia (target temperature 33 °C) or normothermia (target temperature 36.5 to 37.7 °C), according to different study protocols, for at least 24 hours. Additional analyses of mortality and unfavorable functional outcome were performed according to age, sex, initial rhythm, presence or absence of shock on admission, time to return of spontaneous circulation, lactate levels on admission, and the cardiac arrest hospital prognosis score.
Data Extraction and Synthesis: Only patients who experienced OHCA and had a nonshockable rhythm with all causes of cardiac arrest were included. Variables from the 2 studies were available from the original data sets and pooled into a unique database and analyzed. Clinical outcomes were harmonized into a single file, which was checked for accuracy of numbers, distributions, and categories. The last day of follow-up from arrest was recorded for each patient. Adjustment for primary outcome and functional outcome was performed using age, gender, time to return of spontaneous circulation, and bystander cardiopulmonary resuscitation.
Main Outcomes and Measures: The primary outcome was mortality at 3 months; secondary outcomes included unfavorable functional outcome at 3 to 6 months, defined as a Cerebral Performance Category score of 3 to 5.
Results: A total of 912 patients were included, 490 from the TTM2 trial and 422 from the HYPERION trial. Of those, 442 had been assigned to hypothermia (48.4%; mean age, 65.5 years; 287 males [64.9%]) and 470 to normothermia (51.6%; mean age, 65.6 years; 327 males [69.6%]); 571 patients had a first monitored rhythm of asystole (62.6%) and 503 a presumed noncardiac cause of arrest (55.2%). At 3 months, 354 of 442 patients in the hypothermia group (80.1%) and 386 of 470 patients in the normothermia group (82.1%) had died (relative risk [RR] with hypothermia, 1.04; 95% CI, 0.89-1.20; P = .63). On the last day of follow-up, 386 of 429 in the hypothermia group (90.0%) and 413 of 463 in the normothermia group (89.2%) had an unfavorable functional outcome (RR with hypothermia, 0.99; 95% CI, 0.87-1.15; P = .97). The association of hypothermia with death and functional outcome was consistent across the prespecified subgroups.
Conclusions and Relevance: In this individual patient data meta-analysis, including unconscious survivors from OHCA with an initial nonshockable rhythm, hypothermia at 33 °C did not significantly improve survival or functional outcome.

Dates et versions

hal-04671913 , version 1 (16-08-2024)

Identifiants

Citer

Fabio Silvio Taccone, Josef Dankiewicz, Alain Cariou, Gisela Lilja, Pierre Asfar, et al.. Hypothermia vs Normothermia in Patients With Cardiac Arrest and Nonshockable Rhythm. JAMA neurology, 2023, 14 (1), pp.33. ⟨10.1001/jamaneurol.2023.4820⟩. ⟨hal-04671913⟩
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