Issue #4: The Latest in Critical Care, 6/12/23
Induced hypothermia after cardiac arrest is also called “active temperature control” or “targeted temperature management.” The treatment became widespread after a trial (NEJM 2002, n=275) showed large neurologic and survival benefits from hypothermia; however, subsequent trials mostly failed to replicate those findings. A Cochrane review analyzing 12 studies with 3956 participants concluded that:
There was no detectable benefit to cooling to temperatures lower than 36 °C, when the control group was maintained at a targeted 36 °C (3 studies with 1044 participants);
Cooling improved neurologic outcomes, but not survival, as compared to fever prevention (without active cooling) or no intervention (8 studies, n=2870)
Because of a calculated high risk of bias in two studies, the certainty of these conclusions was considered low.
But the most recent TTM2 trial (NEJM 2021, n=1850), which was included in the analysis, by itself cast significant doubt on any benefit of temperature management below…
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