Critical Care volume 28,
Article number: 335, Published: 15 October 2024
Background
The aim of this study was to assess whether hypothermia
increased survival and improved functional outcome when compared with
normothermia in out-of-hospital cardiac arrest (OHCA) patients with similar
characteristics than in previous randomized studies showing benefits for
hypothermia.
Methods
Post hoc analysis of a pragmatic, multicenter, randomized
clinical trial (TTM-2, NCT02908308). In this analysis, the subset of patients
included in the trial who had similar characteristics to patients included in
one previous randomized trial and randomized to hypothermia at 33 °C or
normothermia (i.e. target < 37.8 °C)
were considered. The primary outcome was survival at 6 months;
secondary outcomes included favorable functional outcome at 6 months, defined as a modified Rankin scale of 0–3. Time-to-death and the occurrence of adverse events were also
reported.
Results
From a total of 1891 included in the TTM-2 study, 600
(31.7%) were included in the analysis, 294 in the hypothermia and 306 in the
normothermia group. At 6 months, 207 of the 294 patients (70.4%) in the
hypothermia group and 220 of the 306 patients (71.8%) in the normothermia group
had survived (relative risk with hypothermia, 0.96; 95% confidence interval
[CI], 0.81 to 1.15; P = 0.71). Also, 198 of the 294
(67.3%) in the hypothermia group and 202 of the 306 (66.0%) in the normothermia
group had a favorable functional outcome (relative risk with hypothermia, 1.03;
95% CI, 0.87 to 1.23; P = 0.79). There was a significant
increase in the occurrence of arrythmias in the hypothermia group (62/294,
21.2%) when compared to the normothermia group (43/306, 14.1%—OR 1.49, 95% CI 1.05–2.14; p = 0.026).
Conclusions
In this study, hypothermia at 33˚C did not improve survival
or functional outcome in a subset of patients with similar cardiac arrest
characteristics to patients in whom benefit from hypothermia was shown in prior
studies.
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