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Intravascular versu...
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Glover, Guy W.Guy's and St Thomas' NHS Foundation Trust
(author)
Intravascular versus surface cooling for targeted temperature management after out-of-hospital cardiac arrest - an analysis of the TTM trial data
- Article/chapterEnglish2016
Publisher, publication year, extent ...
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2016-11-26
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Springer Science and Business Media LLC,2016
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LIBRIS-ID:oai:lup.lub.lu.se:3fa5c1c3-b8ff-4401-bf16-b9e767d19ebd
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https://lup.lub.lu.se/record/3fa5c1c3-b8ff-4401-bf16-b9e767d19ebdURI
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https://doi.org/10.1186/s13054-016-1552-6DOI
Supplementary language notes
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Language:English
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Summary in:English
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Subject category:art swepub-publicationtype
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Subject category:ref swepub-contenttype
Notes
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Background: Targeted temperature management is recommended after out-of-hospital cardiac arrest and may be achieved using a variety of cooling devices. This study was conducted to explore the performance and outcomes for intravascular versus surface devices for targeted temperature management after out-of-hospital cardiac arrest. Method: A retrospective analysis of data from the Targeted Temperature Management trial. N=934. A total of 240 patients (26%) managed with intravascular versus 694 (74%) with surface devices. Devices were assessed for speed and precision during the induction, maintenance and rewarming phases in addition to adverse events. All-cause mortality, as well as a composite of poor neurological function or death, as evaluated by the Cerebral Performance Category and modified Rankin scale were analysed. Results: For patients managed at 33°C there was no difference between intravascular and surface groups in the median time taken to achieve target temperature (210 [interquartile range (IQR) 180] minutes vs. 240 [IQR 180] minutes, p=0.58), maximum rate of cooling (1.0 [0.7] vs. 1.0 [0.9] °C/hr, p=0.44), the number of patients who reached target temperature (within 4hours (65% vs. 60%, p=0.30); or ever (100% vs. 97%, p=0.47), or episodes of overcooling (8% vs. 34%, p=0.15). In the maintenance phase, cumulative temperature deviation (median 3.2 [IQR 5.0] °C hr vs. 9.3 [IQR 8.0] °C hr, p=<0.001), number of patients ever out of range (57.0% vs. 91.5%, p=0.006) and median time out of range (1 [IQR 4.0] hours vs. 8.0 [IQR 9.0] hours, p=<0.001) were all significantly greater in the surface group although there was no difference in the occurrence of pyrexia. Adverse events were not different between intravascular and surface groups. There was no statistically significant difference in mortality (intravascular 46.3% vs. surface 50.0%; p=0.32), Cerebral Performance Category scale 3-5 (49.0% vs. 54.3%; p=0.18) or modified Rankin scale 4-6 (49.0% vs. 53.0%; p=0.48). Conclusions: Intravascular and surface cooling was equally effective during induction of mild hypothermia. However, surface cooling was associated with less precision during the maintenance phase. There was no difference in adverse events, mortality or poor neurological outcomes between patients treated with intravascular and surface cooling devices. Trial registration: TTM trial ClinicalTrials.gov number https://clinicaltrials.gov/ct2/show/NCT01020916 NCT01020916; 25 November 2009
Subject headings and genre
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Thomas, Richard M.Royal Free Hospital
(author)
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Vamvakas, GeorgeKing's College London
(author)
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Al-Subaie, NawafSt George's Hospital, London
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Cranshaw, JulesRoyal Bournemouth Hospital
(author)
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Walden, AndrewRoyal Berkshire Hospital
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Wise, Matthew P.University Hospital of Wales
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Ostermann, MarliesGuy's and St Thomas' NHS Foundation Trust
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Thomas-Jones, EmmaCardiff University
(author)
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Cronberg, TobiasLund University,Lunds universitet,Neurologi, Lund,Sektion IV,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Neurology, Lund,Section IV,Department of Clinical Sciences, Lund,Faculty of Medicine,Skåne University Hospital(Swepub:lu)efor-tcr
(author)
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Erlinge, DavidLund University,Lunds universitet,Kardiologi,Sektion II,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Molekylär kardiologi,Forskargrupper vid Lunds universitet,Cardiology,Section II,Department of Clinical Sciences, Lund,Faculty of Medicine,Molecular Cardiology,Lund University Research Groups,Skåne University Hospital(Swepub:lu)kard-der
(author)
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Gasche, YvanGeneva University Hospital
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Hassager, ChristianCopenhagen University Hospital
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Horn, JannekeAcademic Medical Center of University of Amsterdam (AMC)
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Kjaergaard, JesperCopenhagen University Hospital
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Kuiper, MichaelMedical Center Leeuwarden
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Pellis, TommasoSanta Maria degli Angeli Hospital
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Stammet, PascalCentre Hospitalier de Luxembourg
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Wanscher, MichaelCopenhagen University Hospital
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Wetterslev, JørnCopenhagen University Hospital
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Friberg, HansLund 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(Swepub:lu)efor-hfr
(author)
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Nielsen, NiklasLund 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(Swepub:lu)med-nni
(author)
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Guy's and St Thomas' NHS Foundation TrustRoyal Free Hospital
(creator_code:org_t)
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In:Critical Care: Springer Science and Business Media LLC20:11364-8535
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Glover, Guy W.
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Vamvakas, George
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Al-Subaie, Nawaf
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Walden, Andrew
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Wise, Matthew P.
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Ostermann, Marli ...
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Erlinge, David
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Horn, Janneke
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Kjaergaard, Jesp ...
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Kuiper, Michael
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Pellis, Tommaso
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Stammet, Pascal
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Wetterslev, Jørn
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