Aim

To perform a systematic review and meta-analysis on targeted temperature management in adult cardiac arrest patients.

Methods

PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched on June 17, 2021 for clinical trials. The population included adult patients with cardiac arrest. The review included all aspects of targeted temperature management including timing, temperature, duration, method of induction and maintenance, and rewarming. Two investigators reviewed trials for relevance, extracted data, and assessed risk of bias. Data were pooled using random-effects models. Certainty of evidence was evaluated using GRADE.

Results

The systematic search identified 32 trials. Risk of bias was assessed as intermediate for most of the outcomes. For targeted temperature management with a target of 32–34 °C vs. normothermia (which often required active cooling), 9 trials were identified, with six trials included in meta-analyses. Targeted temperature management with a target of 32–34 °C did not result in an improvement in survival (risk ratio: 1.08 [95%CI: 0.89, 1.30]) or favorable neurologic outcome (risk ratio: 1.21 [95%CI: 0.91, 1.61]) at 90 to 180 days after the cardiac arrest (low certainty of evidence). Three trials assessed different hypothermic temperature targets and found no difference in outcomes (low certainty of evidence). Ten trials were identified comparing prehospital cooling vs. no prehospital cooling with no improvement in survival (risk ratio: 1.01 [95%CI: 0.92, 1.11]) or favorable neurologic outcome (risk ratio: 1.00 [95%CI: 0.90, 1.11]) at hospital discharge (moderate certainty of evidence).

Conclusions

Among adult patients with cardiac arrest, the use of targeted temperature management at 32–34 °C, when compared to normothermia, did not result in improved outcomes in this meta-analysis. There was no effect of initiating targeted temperature management prior to hospital arrival. These findings warrant an update of international cardiac arrest guidelines.

中文翻译：

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成人心脏骤停的目标温度管理：系统评价和荟萃分析

目的

对成人心脏骤停患者的目标温度管理进行系统评价和荟萃分析。

方法

PubMed、Embase 和 Cochrane Central Register of Controlled Trials 于 2021 年 6 月 17 日进行了临床试验检索。人群包括心脏骤停的成年患者。审查包括目标温度管理的所有方面，包括时间、温度、持续时间、诱导和维持方法以及复温。两名研究人员审查了试验的相关性、提取数据并评估了偏倚风险。使用随机效应模型汇总数据。使用 GRADE 评估证据的确定性。

结果

系统搜索确定了 32 项试验。大多数结果的偏倚风险被评估为中间风险。对于 32–34 °C 与常温（通常需要主动降温）的目标温度管理，确定了 9 项试验，其中 6 项试验纳入荟萃分析。目标温度为 32-34 °C 的目标温度管理并未提高生存率（风险比：1.08 [95%CI: 0.89, 1.30]）或有利的神经系统结局（风险比：1.21 [95%CI: 0.91] , 1.61]）在心脏骤停后 90 至 180 天（证据质量低）。三项试验评估了不同的低温目标，发现结果没有差异（证据质量低）。确定了 10 项试验，比较了院前降温与没有院前降温但生存率没有改善（风险比：1.01 [95%CI：0.92，

结论

在心脏骤停的成年患者中，与常温相比，使用 32-34°C 的目标温度管理并没有改善这项荟萃分析的结果。在到达医院之前启动有针对性的温度管理没有效果。这些发现需要更新国际心脏骤停指南。