by Xueli Liao, Ziyu Zhou, Manhong Zhou, Hui Tang, Menglong
Feng, Bujin Kou, Ni Zhu, Futuan Liao and Liaozhang Wu
Critical Care volume 24,
Article number: 27 (2020)
Objectives
This study conducted a meta-analysis to assess the
effectiveness, stability, and safety of mild therapeutic hypothermia (TH)
induced by endovascular cooling (EC) and surface cooling (SC) and its effect on
ICU, survival rate, and neurological function integrity in adult CA patients.
Methods
We developed inclusion criteria, intervention protocols,
results, and data collection. The results included outcomes during target
temperature management as well as ICU stay, survival rate, and neurological
functional integrity. The characteristics of the included population and each
study were analyzed.
Results
Four thousand nine hundred thirteen participants met the
inclusion criteria. Those receiving EC had a better cooling efficiency (cooling
rates MD = 0.31[0.13, 0.50], p < 0.01; induced cooling times MD = − 90.45[− 167.57,
− 13.33], p = 0.02; patients achieving the target temperature RR = 1.60[1.19,
2.15], p < 0.01) and thermal stability during the maintenance phase
(maintenance time MD = 2.35[1.22, 3.48], p < 0.01; temperature
fluctuation MD = − 0.68[− 1.03, − 0.33], p < 0.01; overcooling RR = 0.33[0.23,
0.49], p < 0.01). There were no differences in ICU survival rate (RR = 1.22[0.98,
1.52], p = 0.07, I2 = 0%) and hospital survival rate (RR = 1.02
[0.96, 1.09], p = 0.46, I2 = 0%), but EC reduced the length of stay
in ICU (MD = − 1.83[− 3.45, − 0.21], p = 0.03, I2 = 49%) and improved
outcome of favorable neurological function at discharge (RR = 1.15[1.04, 1.28], p < 0.01, I2 = 0%).
EC may delay the hypothermia initiation time, and there was no significant
difference between the two cooling methods in the time from the start of
patients’ cardiac arrest to achieve the target temperature (MD = − 46.64[− 175.86,
82.58]). EC was superior to non-ArcticSun in terms of cooling efficiency.
Although there was no statistical difference in ICU survival rate, ICU length
of stay, and hospitalization survival rate, in comparison to non-ArcticSun, EC
improved rates of neurologically intact survival (RR = 1.16 [1.01, 1.35], p = 0.04, I2 = 0%).
Conclusions
Among adult patients receiving cardiopulmonary
resuscitation, although there is no significant difference between the two
cooling methods in the time from the start of cardiac arrest to achieve the
target temperature, the faster cooling rate and more stable cooling process in
EC shorten patients’ ICU hospitalization time and help more patients obtain
good neurological prognosis compared with patients receiving SC. Meanwhile,
although EC has no significant difference in patient outcomes compared with
ArcticSun, EC has improved rates of neurologically intact survival.
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