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Sökning: WFRF:(Boulain Thierry) > (2024) > Hypothermia vs Norm...

Hypothermia vs Normothermia in Patients With Cardiac Arrest and Nonshockable Rhythm : A Meta-Analysis

Taccone, Fabio Silvio (författare)
Univ Libre Bruxelles ULB, Hop Univ Bruxelles HUB, Dept Intens Care, Brussels, Belgium.;ROSC Network, Paris, France.,Université Libre de Bruxelles (ULB)
Dankiewicz, Josef (författare)
Lund Univ, Skane Univ Hosp Lund, Dept Cardiol, Lund, Sweden.,Skåne University Hospital
Cariou, Alain (författare)
ROSC Network, Paris, France.;Paris Cite Univ, Cochin Hosp, AP HP, Dept Intens Care, Paris, France.
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Lilja, Gisela (författare)
Lund University,Lunds universitet,Neurologi, Lund,Sektion IV,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Centrum för hjärtstopp,Forskargrupper vid Lunds universitet,Brain Injury After Cardiac Arrest,Neurology, Lund,Section IV,Department of Clinical Sciences, Lund,Faculty of Medicine,Center for cardiac arrest,Lund University Research Groups,Skåne University Hospital,Lund Univ, Neurol Dept Clin Sci, Lund, Sweden.;Skane Univ Hosp, Dept Neurol, Lund, Sweden.
Asfar, Pierre (författare)
CHU Angers, Dept Med Intens Reanimat, Angers, France.
Belohlavek, Jan (författare)
Charles Univ Prague, Fac Med 1, Dept Med 2, Cardiovasc Med, Prague, Czech Republic.;Gen Univ Hosp, Prague, Czech Republic.,General University Hospital in Prague
Boulain, Thierry (författare)
Hop Source Orleans, Ctr Hosp Reg Orleans, Med Intens Care Unit, Orleans, France.
Colin, Gwenhael (författare)
Dist Hosp Ctr, Med Surg Intens Care Unit, La Roche Sur Yon, France.
Cronberg, Tobias (författare)
Lund University,Lunds universitet,Neurologi, Lund,Sektion IV,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Centrum för hjärtstopp,Forskargrupper vid Lunds universitet,Brain Injury After Cardiac Arrest,Neurology, Lund,Section IV,Department of Clinical Sciences, Lund,Faculty of Medicine,Center for cardiac arrest,Lund University Research Groups,Skåne University Hospital,Lund Univ, Neurol Dept Clin Sci, Lund, Sweden.;Skane Univ Hosp, Dept Neurol, Lund, Sweden.
Frat, Jean-Pierre (författare)
Univ Poitiers, INSERM, CIC 1402, Grp IS ALIVE, Poitiers, France.,Poitiers University
Friberg, Hans (författare)
Lund University,Lunds universitet,Anestesiologi och intensivvård,Sektion II,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Centrum för hjärtstopp,Forskargrupper vid Lunds universitet,SWECRIT,Anesthesiology and Intensive Care,Section II,Department of Clinical Sciences, Lund,Faculty of Medicine,Center for cardiac arrest,Lund University Research Groups,Skåne University Hospital,Lund Univ, Dept Clin Sci Anesthesiol & Intens Care, Lund, Sweden.;Skane Univ Hosp, Intens & Perioperat Care, Malmö, Sweden.
Grejs, Anders M. (författare)
Aarhus Univ Hosp, Dept Intens Care Med, Aarhus, Denmark.;Aarhus Univ, Dept Clin Med, Aarhus, Denmark.,Aarhus University Hospital
Grillet, Guillaume (författare)
Dist Hosp Ctr, Med Surg Intens Care Unit, Lorient, France.
Girardie, Patrick (författare)
Univ Lille, CHU Lille, Fac Med, Med Intens Reanimat, Lille, France.,University of Lille
Haenggi, Matthias (författare)
Univ Bern, Bern Univ Hosp, Inselspital, Dept Intens Care Med, Bern, Switzerland.,Bern University Hospital
Hovdenes, Jan (författare)
Natl Hosp Norway, Dept Anesthesia & Intens Care, Oslo Univ Hosp, Oslo, Norway.,Norwegian Radium Hospital
Jakobsen, Janus Christian (författare)
Rigshosp, Copenhagen Univ Hosp, Ctr Clin Intervent Res, Copenhagen Trial Unit,Capital Reg, Copenhagen, Denmark.;Univ Southern Denmark, Fac Hlth Sci, Dept Reg Hlth Res, Odense, Denmark.,Copenhagen University Hospital,University of Southern Denmark
Levin, Helena (författare)
Lund University,Lunds universitet,Anestesiologi och intensivvård,Sektion II,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Centrum för hjärtstopp,Forskargrupper vid Lunds universitet,Anesthesiology and Intensive Care,Section II,Department of Clinical Sciences, Lund,Faculty of Medicine,Center for cardiac arrest,Lund University Research Groups,Skåne University Hospital,Lund Univ, Dept Res & Educ, Lund, Sweden.;Skane Univ Hosp, Lund, Sweden.
Merdji, Hamid (författare)
Hop Univ Strasbourg, Nouvel Hop Civil, Serv Med Intens Reanimat, Strasbourg, France.;Univ Strasbourg UNISTRA, INSERM, UMR 1260, Regenerat Nanomed,Federat Med Translat Strasbourg, Strasbourg, France.,CHRU Nouvel Hôpital Civil
Njimi, Hassane (författare)
Univ Libre Bruxelles ULB, Hop Univ Bruxelles HUB, Dept Intens Care, Brussels, Belgium.,Université Libre de Bruxelles (ULB)
Pelosi, Paolo (författare)
Univ Genoa, San Martino Policlin Hosp, Dept Anesthesiol & Crit Care, IRCCS Oncol & Neurosci,Dept Surg Sci & Integrated, Genoa, Italy.,Ospedale Policlinico San Martino,University Hospital of Wales,Univ Hosp Wales, Adult Crit Care, Cardiff, Wales.
Rylander, Christian (författare)
Uppsala University,Uppsala universitet,Anestesiologi och intensivvård
Saxena, Manoj (författare)
George Inst Global Hlth, Crit Care & Trauma Div, Sydney, NSW, Australia.;St George Hosp, Dept Intens Care Med, Kogarah, NSW, Australia.,St George Hospital, Sidney,The George Institute for Global Health
Thomas, Matt (författare)
Southmead Hosp, Dept Anaesthesia, Bristol, Avon, England.
Young, Paul J. (författare)
Wellington Reg Hosp, Dept Intens Care, Capital & Coast Dist Hlth Board, Wellington, New Zealand.;Med Res Inst New Zealand, Wellington, New Zealand.;Monash Univ, Australian & New Zealand Intens Care Res Ctr, Melbourne, Vic, Australia.;Univ Melbourne, Dept Crit Care, Melbourne, Vic, Australia.,Monash University,Wellington Hospital, New Zealand,University of Melbourne,Medical Research Institute of New Zealand
Wise, Matt P. (författare)
Univ Hosp Wales, Adult Crit Care, Cardiff, Wales.
Nielsen, Niklas (författare)
Univ Poitiers, INSERM, CIC 1402, Grp IS ALIVE, Poitiers, France.,Poitiers University
Lascarrou, Jean-Baptiste (författare)
ROSC Network, Paris, France.;CHU Nantes, Med Intens Reanimat, Nantes, France.;Univ Paris Cite, INSERM, PARCC, F-75015 Paris, France.,Nantes University Hospital
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Univ Libre Bruxelles ULB, Hop Univ Bruxelles HUB, Dept Intens Care, Brussels, Belgium;ROSC Network, Paris, France. Université Libre de Bruxelles (ULB) (creator_code:org_t)
American Medical Association (AMA), 2024
2024
Engelska.
Ingår i: JAMA Neurology. - : American Medical Association (AMA). - 2168-6149 .- 2168-6157. ; 81:2, s. 126-133
Relaterad länk:
http://dx.doi.org/10...
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https://urn.kb.se/re...
https://doi.org/10.1...
https://lup.lub.lu.s...
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  • Tidskriftsartikel (refereegranskat)
Abstract Ämnesord
Stäng  
  • Importance  International guidelines recommend body temperature control below 37.8 °C in unconscious patients with out-of-hospital cardiac arrest (OHCA); however, a target temperature of 33 °C might lead to better outcomes when the initial rhythm is nonshockable.Objective  To assess whether hypothermia at 33 °C increases survival and improves function when compared with controlled normothermia in unconscious adults resuscitated from OHCA with initial nonshockable rhythm.Data Sources  Individual patient data meta-analysis of 2 multicenter, randomized clinical trials (Targeted Normothermia after Out-of-Hospital Cardiac Arrest [TTM2; NCT02908308] and HYPERION [NCT01994772]) with blinded outcome assessors. Unconscious patients with OHCA and an initial nonshockable rhythm were eligible for the final analysis.Study Selection  The study cohorts had similar inclusion and exclusion criteria. Patients were randomized to hypothermia (target temperature 33 °C) or normothermia (target temperature 36.5 to 37.7 °C), according to different study protocols, for at least 24 hours. Additional analyses of mortality and unfavorable functional outcome were performed according to age, sex, initial rhythm, presence or absence of shock on admission, time to return of spontaneous circulation, lactate levels on admission, and the cardiac arrest hospital prognosis score.Data Extraction and Synthesis  Only patients who experienced OHCA and had a nonshockable rhythm with all causes of cardiac arrest were included. Variables from the 2 studies were available from the original data sets and pooled into a unique database and analyzed. Clinical outcomes were harmonized into a single file, which was checked for accuracy of numbers, distributions, and categories. The last day of follow-up from arrest was recorded for each patient. Adjustment for primary outcome and functional outcome was performed using age, gender, time to return of spontaneous circulation, and bystander cardiopulmonary resuscitation.Main Outcomes and Measures  The primary outcome was mortality at 3 months; secondary outcomes included unfavorable functional outcome at 3 to 6 months, defined as a Cerebral Performance Category score of 3 to 5.Results  A total of 912 patients were included, 490 from the TTM2 trial and 422 from the HYPERION trial. Of those, 442 had been assigned to hypothermia (48.4%; mean age, 65.5 years; 287 males [64.9%]) and 470 to normothermia (51.6%; mean age, 65.6 years; 327 males [69.6%]); 571 patients had a first monitored rhythm of asystole (62.6%) and 503 a presumed noncardiac cause of arrest (55.2%). At 3 months, 354 of 442 patients in the hypothermia group (80.1%) and 386 of 470 patients in the normothermia group (82.1%) had died (relative risk [RR] with hypothermia, 1.04; 95% CI, 0.89-1.20; P = .63). On the last day of follow-up, 386 of 429 in the hypothermia group (90.0%) and 413 of 463 in the normothermia group (89.2%) had an unfavorable functional outcome (RR with hypothermia, 0.99; 95% CI, 0.87-1.15; P = .97). The association of hypothermia with death and functional outcome was consistent across the prespecified subgroups.Conclusions and Relevance  In this individual patient data meta-analysis, including unconscious survivors from OHCA with an initial nonshockable rhythm, hypothermia at 33 °C did not significantly improve survival or functional outcome.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Anestesi och intensivvård (hsv//swe)
MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Anesthesiology and Intensive Care (hsv//eng)
MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Kardiologi (hsv//swe)
MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)

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