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  • Lilja, GiselaSkåne University Hospital (author)

Effects of Hypothermia vs Normothermia on Societal Participation and Cognitive Function at 6 Months in Survivors After Out-of-Hospital Cardiac Arrest A Predefined Analysis of the TTM2 Randomized Clinical Trial

  • Article/chapterEnglish2023

Publisher, publication year, extent ...

  • 2023

Numbers

  • LIBRIS-ID:oai:gup.ub.gu.se/331551
  • https://gup.ub.gu.se/publication/331551URI
  • https://doi.org/10.1001/jamaneurol.2023.2536DOI
  • https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-515719URI
  • https://lup.lub.lu.se/record/97162b4e-ee4a-463e-a010-117db388a8daURI
  • http://kipublications.ki.se/Default.aspx?queryparsed=id:153483057URI

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  • Language:English

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  • Subject category:ref swepub-contenttype
  • Subject category:art swepub-publicationtype

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  • IMPORTANCE The Targeted Hypothermia vs Targeted Normothermia After Out-of-Hospital Cardiac Arrest (TTM2) trial reported no difference in mortality or poor functional outcome at 6 months after out-of-hospital cardiac arrest (OHCA). This predefined exploratory analysis provides more detailed estimation of brain dysfunction for the comparison of the 2 intervention regimens. OBJECTIVES To investigate the effects of targeted hypothermia vs targeted normothermia on functional outcome with focus on societal participation and cognitive function in survivors 6 months after OHCA. DESIGN, SETTING, AND PARTICIPANTS This study is a predefined analysis of an international multicenter, randomized clinical trial that took place from November 2017 to January 2020 and included participants at 61 hospitals in 14 countries. A structured follow-up for survivors performed at 6 months was by masked outcome assessors. The last follow-up took place in October 2020. Participants included 1861 adult (older than 18 years) patients with OHCA who were comatose at hospital admission. At 6 months, 939 of 1861 were alive and invited to a follow-up, of which 103 of 939 declined or were missing. INTERVENTIONS Randomization 1:1 to temperature control with targeted hypothermia at 33 degrees C or targeted normothermia and early treatment of fever (37.8 degrees C or higher). MAIN OUTCOMES AND MEASURES Functional outcome focusing on societal participation assessed by the Glasgow Outcome Scale Extended ([GOSE] 1 to 8) and cognitive function assessed by the Montreal Cognitive Assessment ([MoCA] 0 to 30) and the Symbol Digit Modalities Test ([SDMT] z scores). Higher scores represent better outcomes. RESULTS At 6 months, 836 of 939 survivors with a mean age of 60 (SD, 13) (range, 18 to 88) years (700 of 836 male [84%]) participated in the follow-up. There were no differences between the 2 intervention groups in functional outcome focusing on societal participation (GOSE score, odds ratio, 0.91; 95% CI, 0.71-1.17; P =.46) or in cognitive function by MoCA (mean difference, 0.36; 95% CI,-0.33 to 1.05; P =.37) and SDMT (mean difference, 0.06; 95% CI,-0.16 to 0.27; P =.62). Limitations in societal participation (GOSE score less than 7) were common regardless of intervention (hypothermia, 178 of 415 [43%]; normothermia, 168 of 419 [40%]). Cognitive impairment was identified in 353 of 599 survivors (59%). CONCLUSIONS In this predefined analysis of comatose patients after OHCA, hypothermia did not lead to better functional outcome assessed with a focus on societal participation and cognitive function than management with normothermia. At 6 months, many survivors had not regained their pre-arrest activities and roles, and mild cognitive dysfunction was common.

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  • Ullén, SusannSkåne University Hospital(Swepub:lu)su7040ul (author)
  • Dankiewicz, JosefLund University,Lunds universitet,Kardiologi,Sektion II,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Cardiology,Section II,Department of Clinical Sciences, Lund,Faculty of Medicine,Skåne University Hospital(Swepub:lu)med-jfd (author)
  • Friberg, HansLund University,Lunds universitet,Centrum för hjärtstopp,Forskargrupper vid Lunds universitet,SWECRIT,Center for cardiac arrest,Lund University Research Groups,Skåne University Hospital(Swepub:lu)efor-hfr (author)
  • Levin, HelenaLund University,Lunds universitet,Centrum för hjärtstopp,Forskargrupper vid Lunds universitet,Center for cardiac arrest,Lund University Research Groups,Skåne University Hospital(Swepub:lu)ores-hal (author)
  • Blennow Nordström, ErikLund 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(Swepub:lu)er0251bl (author)
  • Heimburg, KatarinaLund University,Lunds universitet,Brain Injury After Cardiac Arrest,Forskargrupper vid Lunds universitet,Lund University Research Groups,Skåne University Hospital(Swepub:lu)ka7876he (author)
  • Jakobsen, J. C.Copenhagen University Hospital (author)
  • Ahlqvist, Marita,1948University of Gothenburg,Gothenburg University,Göteborgs universitet,Institutionen för kliniska vetenskaper, Avdelningen för anestesiologi och intensivvård,Institute of Clinical Sciences, Department of Anesthesiology and Intensive care(Swepub:gu)xahmar (author)
  • Bass, F.The George Institute for Global Health (author)
  • Belohlavek, J.General University Hospital in Prague (author)
  • Olsen, R. B.Sørlandet Hospital (author)
  • Cariou, A.Cochin Hospital (author)
  • Eastwood, G.Austin Hospital (author)
  • Fanebust, H. R.Haukeland University Hospital (author)
  • Grejs, A. M.Aarhus University Hospital (author)
  • Grimmer, L.University Hospitals Bristol and Weston NHS Trust (author)
  • Nielsen, NiklasLund University,Lunds universitet,Centrum för hjärtstopp,Forskargrupper vid Lunds universitet,SEBRA Sepsis and Bacterial Resistance Alliance,Center for cardiac arrest,Lund University Research Groups,Helsingborg Hospital(Swepub:lu)med-nni (author)
  • Hovdenes, J. (author)
  • Hrecko, J. (author)
  • Iten, M. (author)
  • Johansen, H. (author)
  • Keeble, T. R. (author)
  • Kirkegaard, H. (author)
  • Lascarrou, J. B. (author)
  • Leithner, C. (author)
  • Lesona, M. E. (author)
  • Levis, A. (author)
  • Mion, M. (author)
  • Moseby-Knappe, MarionLund University,Lunds universitet,Brain Injury After Cardiac Arrest,Forskargrupper vid Lunds universitet,Neurologiska skador vid akut aortadissektion typ A,Lund University Research Groups,Neurological injury in acute type A aortic dissection,Skåne University Hospital(Swepub:lu)med-mmy (author)
  • Navarra, L. (author)
  • Nordberg, P.Karolinska Institutet (author)
  • Pelosi, P. (author)
  • Quayle, R. (author)
  • Rylander, ChristianUppsala universitet,Anestesiologi och intensivvård(Swepub:uu)chrry684 (author)
  • Sandberg, H. (author)
  • Saxena, M. (author)
  • Schrag, C. (author)
  • Siranec, M. (author)
  • Tiziano, C. (author)
  • Vignon, P. (author)
  • Wendel-Garcia, P. D. (author)
  • Wise, M. P. (author)
  • Wright, K. (author)
  • Nielsen, N. (author)
  • Cronberg, TobiasLund 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(Swepub:lu)efor-tcr (author)
  • Skåne University HospitalKardiologi (creator_code:org_t)

Related titles

  • In:Jama Neurology80:10, s. 1070-10792168-61492168-6157

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