OBJECTIVE: 

The aim of the study was to compare the effect of intravascular cooling (IC), surface cooling with temperature feedback (SCF), and surface cooling without temperature feedback (SCnoF) on neurologic outcome and survival in patients successfully resuscitated from cardiac arrest (CA) and treated with targeted temperature management (TTM) at 32–34°C.

DATA SOURCES: 

We performed a systematic review on Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, MEDLINE, SCOPUS, CINAHL, Web of Science, and Clinical Trials up to June 30, 2021.

STUDY SELECTION: 

We included randomized and nonrandomized studies on IC, SCF, and SCnoF in adult humans resuscitated from CA undergoing TTM, reporting neurologic outcome or survival.

DATA EXTRACTION: 

We performed a network meta-analysis to assess the comparative effects of IC, SCF, and SCnoF. The overall effect between two cooling methods included the effect of direct and indirect comparisons. Results are given as odds ratios (OR) and 95% CIs. Rankograms estimated the probability of TTM methods being ranked first, second, and third best interventions.

DATA SYNTHESIS: 

A total of 14 studies involving 4,062 patients met the inclusion criteria. Four studies were randomized controlled studies, and 10 studies were nonrandomized observational studies. IC compared with SCnoF was significantly associated with better neurologic outcome (OR, 0.6; 95% CI, 0.49–0.74) and survival (OR, 0.8; 95% CI, 0.66–0.96). IC compared with SCF, and SCF compared with SCnoF did not show significant differences in neurologic outcome and survival. The rankogram showed that IC had the highest probability to be the most beneficial cooling method, followed by SCF and SCnoF.

CONCLUSIONS: 

Our results suggest that in patients resuscitated from CA and treated with TTM at 32–34°C, IC has the highest probability of being the most beneficial cooling method for survival and neurologic outcome.

中文翻译：

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心脏骤停复苏患者的血管内冷却与表面冷却：以温度反馈为重点的系统回顾和网络荟萃分析

客观的： 

该研究的目的是比较血管内冷却 (IC)、带温度反馈的表面冷却 (SCF) 和不带温度反馈的表面冷却 (SCnoF) 对心脏骤停 (CA) 成功复苏的患者神经系统结果和生存的影响并在 32–34°C 下进行目标温度管理(TTM)处理。

数据源： 

我们对截至 2021 年 6 月 30 日的 Cochrane 对照试验中央注册库、Cochrane 系统评价数据库、MEDLINE、SCOPUS、CINAHL、Web of Science 和临床试验进行了系统评价。

研究选择： 

我们纳入了对接受 TTM 的 CA 复苏的成年人进行的 IC、SCF 和 SCnoF 的随机和非随机研究，报告神经系统结果或生存情况。

数据提取： 

我们进行了网络荟萃分析来评估 IC、SCF 和 SCnoF 的比较效果。两种冷却方式的总体效果包括直接比较效果和间接比较效果。结果以比值比 (OR) 和 95% CI 形式给出。排名图估计了 TTM 方法被列为第一、第二和第三最佳干预措施的概率。

数据综合： 

共有 14 项研究涉及 4,062 名患者，符合纳入标准。4 项研究为随机对照研究，10 项研究为非随机观察研究。与 SCnoF 相比，IC 与更好的神经系统结局（OR，0.6；95% CI，0.49–0.74）和生存率（OR，0.8；95% CI，0.66–0.96）显着相关。IC与SCF相比，以及SCF与SCnoF相比，在神经系统结果和生存方面没有表现出显着差异。排名图显示 IC 最有可能成为最有益的冷却方法，其次是 SCF 和 SCnoF。

结论： 

我们的结果表明，对于从 CA 中复苏并在 32-34°C 下接受 TTM 治疗的患者，IC 最有可能成为对生存和神经系统结果最有益的降温方法。