Advertisement

Predictors of survival and favorable neurological outcome in patients treated with targeted temperature management after cardiac arrest: A systematic review and meta-analysis

  • Qiang Zhang
    Affiliations
    Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
    Search for articles by this author
  • Zhijiang Qi
    Affiliations
    Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
    Search for articles by this author
  • Bo Liu
    Affiliations
    Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
    Search for articles by this author
  • Chunsheng Li
    Correspondence
    Corresponding author at: Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation, Beijing Chao-Yang Hospital, Capital Medical University, 8# Worker's Stadium South Road, Chao-Yang District, Beijing 100020, China.
    Affiliations
    Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
    Search for articles by this author

      Abstract

      This study was aimed at a serial evaluation of the prognostic values of initial shockable rhythm, bystander cardiopulmonary resuscitation (CPR) and gender for neurological outcome and survival in adults treated with targeted temperature management (TTM) following cardiac arrest (CA). PubMed, Embase and the Cochrane Library were searched for eligible studies. Pooled odds ratio (OR) with 95% confidence intervals (CIs) was calculated to evaluate prognostic values using RevMan 5.3. The outcomes were favorable neurological outcome (defined as cerebral performance category of 1 and 2) and survival. Seventeen studies were subjected to the meta-analysis. Favorable neurological outcome was associated with significantly higher odds of an initial shockable rhythm (OR: 7.63, 95%CI: 6.51–8.96), bystander CPR (OR: 1.44, 95%CI: 1.14–1.82), male (OR: 1.39, 95%CI: 1.20–1.61). Survival was associated with higher odds of an initial shockable rhythm (OR: 4.88, 95%CI: 3.18–4.79), higher odds of bystander CPR (OR: 1.71, 95%CI: 1.05–2.77). No significant association was found between survival and male. In adult patients treated with TTM, initial shockable rhythm, bystander CPR and male sex were associated with a higher likelihood of favorable neurological outcome. Initial shockable rhythm and bystander CPR were associated with a higher likelihood of survival. These factors could help in identifying patients who are eligible for TTM.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Heart & Lung: The Journal of Cardiopulmonary and Acute Care
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Sans S
        • Kesteloot H
        • Kromhout D
        The burden of cardiovascular diseases mortality in Europe. Task Force of the European Society of Cardiology on Cardiovascular Mortality and Morbidity Statistics in Europe.
        Eur Heart J. 1997; 18: 1231-1248
        • Saritas A
        • Cinleti BA
        • Zincircioglu C
        • Uzun U
        • Kose I
        • Senoglu N
        • et al.
        Effect of regional cerebral oximetry to estimate neurologic prognostic outcomes in patients administered targeted temperature management.
        Am J Emerg Med. 2018; Apr 9 (pii: S0735-6757(18)30291-2)
      1. Hypothermia after Cardiac Arrest Study Group. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest.
        N Engl J Med. 2002; 346: 549-556
        • Peberdy MA
        • Callaway CW
        • Neumar RW
        • et al.
        Part 9: post-cardiac arrest care: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.
        Circulation. 2010; 122: S768-S786
        • Wong GC
        • van Diepen S
        • Ainsworth C
        • et al.
        Canadian Cardiovascular Society/Canadian Cardiovascular Critical Care Society/Canadian Association of Interventional Cardiology Position statement on the optimal care of the postarrest patient.
        Can J Cardiol. 2017; 33: 1-16
        • Bernard S.A
        • Gray T.W
        • Buist M.D
        • Jones B.M
        • Silvester W
        • Gutteridge G
        • Smith K
        • et al.
        Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia,.
        N Engl J Med. 2002; 346: 557-563
        • Bernard SA
        • Gray TW
        • Buist MD
        • et al.
        Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia.
        N Engl J Med. 2002; 346: 557-563
        • Oddo M
        • Ribordy V
        • Feihl F
        • et al.
        Early predictors of outcome in comatose survivors of ventricular fibrillation and non-ventricular fibrillation cardiac arrest treated with hypothermia: a prospective study.
        Crit Care Med. 2008; 36: 2296-2301
        • Nuzzo A
        • Peron N
        • Voicu S
        • Megarbane B
        • Deye N
        • et al.
        Targeted temperature management for non-shockable cardiac arrests: the debate must go on.
        J Thorac Dis. 2018; 10: 1304-1307
        • Nolan JP
        • Soar J
        • Cariou A
        • et al.
        European Resuscitation Council and European Society of Intensive Care Medicine 2015 guidelines for post-resuscitation care.
        Intensive Care Med. 2015; 41: 2039-2056
        • Callaway CW
        • Donnino MW
        • Fink EL
        • et al.
        Part 8: post-cardiac arrest care: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care.
        Circulation. 2015; 132: S465-S482
        • Sasson C
        • Rogers MA
        • Dahl J
        • Kellermann AL
        • et al.
        Predictors of survival from out-of-hospital cardiac arrest: a systematic review and meta-analysis.
        Circ Cardiovasc Qual Outcomes. 2010; 3: 63-81
        • Geurts M
        • Macleod MR
        • Kollmar R
        • Kremer PH
        • Van der Worp HB
        • et al.
        Therapeutic hypothermia and the risk of infection: a systematic review and meta-analysis.
        Crit Care Med. 2014; 42: 231-242
        • Samaniego EA
        • Mlynash M
        • Caulfield AF
        • Eyngorn I
        • Wijman C
        • et al.
        Sedation confounds outcome prediction in cardiac arrest survivors treated with hypothermia.
        Neurocrit Care. 2011; 15: 113-119
        • Liberati A
        • Altman DG
        • Tetzlaff J
        • et al.
        The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration.
        BMJ. 2009; 339: b2700
        • Takada M
        • Sozu T
        • Sato T
        Practical approaches for design and analysis of clinical trials of infertility treatments:.
        Crossover designs and the Mantel-Haenszel method are recommended, PHARM STAT. 2015; 14: 198-204
        • Egger M
        • Davey SG
        • Schneider M
        • Minder C
        • et al.
        Bias in meta-analysis detected by a simple, graphical test.
        BMJ. 1997; 315: 629-634
        • Vattanavanit V
        • Bhurayanontachai R
        Clinical outcomes of 3-year experience of targeted temperature management in patients with out-of-hospital cardiac arrest at Songklanagarind Hospital in Southern Thailand: an analysis of the MICU-TTM registry.
        Open Access Emerg Med. 2016; 8: 67-72
        • Tetsuhara K
        • Kato H
        • Kanemura T
        • Kiriu N
        • et al.
        Severe acidemia on arrival not predictive of neurologic outcomes in post-cardiac arrest patients.
        Am J Emerg Med. 2016; 34: 425-428
        • Okada K
        • Ohde S
        • Otani N
        • et al.
        Prediction protocol for neurological outcome for survivors of out-of-hospital cardiac arrest treated with targeted temperature management.
        Resuscitation. 2012; 83: 734-739
        • Lee SJ
        • Jeung KW
        • Lee BK
        • et al.
        Impact of case volume on outcome and performance of targeted temperature management in out-of-hospital cardiac arrest survivors.
        Am J Emerg Med. 2015; 33: 31-36
        • Lee DH
        • Lee BK
        • Jeung KW
        • et al.
        Neuromuscular blockade requirement is associated with good neurologic outcome in cardiac arrest survivors treated with targeted temperature management.
        J Crit Care. 2017; 40: 218-224
        • Lee BK
        • Jeung KW
        • Jung YH
        • et al.
        Relationship between timing of cooling and outcomes in adult comatose cardiac arrest patients treated with targeted temperature management.
        Resuscitation. 2017; 113: 135-141
        • Kim WY
        • Ahn S
        • Hong JS
        • et al.
        The impact of downtime on neurologic intact survival in patients with targeted temperature management after out-of-hospital cardiac arrest: national multicenter cohort study.
        Resuscitation. 2016; 105: 203-208
        • Kim JC
        • Lee BK
        • Lee DH
        • et al.
        Association between lactate clearance during post-resuscitation care and neurologic outcome in cardiac arrest survivors treated with targeted temperature management.
        Clin Exp Emerg Med. 2017; 4: 10-18
        • Kiehl EL
        • Parker AM
        • Matar RM
        • et al.
        C-GRApH: a validated scoring system for early stratification of neurologic outcome after out-of-hospital cardiac arrest treated with targeted temperature management.
        J Am Heart Assoc. 2017; 6 (20;6(5). pii: e003821)
        • Jung YH
        • Lee BK
        • Lee DH
        • Lee SM
        • Cho YS
        • Jeung KW
        • et al.
        The association of body mass index with outcomes and targeted temperature management practice in cardiac arrest survivors.
        Am J Emerg Med. 2017; 35: 268-273
        • Jeon CH
        • Park JS
        • Lee JH
        • et al.
        Comparison of brain computed tomography and diffusion-weighted magnetic resonance imaging to predict early neurologic outcome before target temperature management comatose cardiac arrest survivors.
        Resuscitation. 2017; 118: 21-26
        • Huang CH
        • Tsai MS
        • Ong HN
        • et al.
        Association of hemodynamic variables with in-hospital mortality and favorable neurological outcomes in post-cardiac arrest care with targeted temperature management.
        Resuscitation. 2017; 120: 146-152
        • Hsu CH
        • Li J
        • Cinousis MJ
        • et al.
        Cerebral performance category at hospital discharge predicts long-term survival of cardiac arrest survivors receiving targeted temperature management.
        Crit Care Med. 2014; 42: 2575-2581
        • Gilje P
        • Koul S
        • Thomsen JH
        • et al.
        High-sensitivity troponin-T as a prognostic marker after out-of-hospital cardiac arrest - a targeted temperature management (TTM) trial substudy.
        Resuscitation. 2016; 107: 156-161
        • Agarwal S
        • Presciutti A
        • Roth W
        • et al.
        Determinants of Long-Term Neurological Recovery Patterns Relative to Hospital Discharge Among Cardiac Arrest Survivors.
        CRIT CARE MED. 2018; 46: e141-e150
        • Lamartine MM
        • Taccone FS
        • Depondt C
        • et al.
        The prognostic value of 48-h continuous EEG during therapeutic hypothermia after cardiac arrest.
        Neurocrit Care. 2016; 24: 153-162
        • Ahn S
        • Lee BK
        • Youn CS
        • et al.
        Predictors of good neurologic outcome after resuscitation beyond 30 min in out-of-hospital cardiac arrest patients undergoing therapeutic hypothermia.
        Intern Emerg Med. 2018; 13: 413-419
        • Safar P.
        Cerebral resuscitation after cardiac arrest: research initiatives and future directions.
        Ann Emerg Med. 1993; 22: 324-349
        • Oh SH
        • Park KN
        • Lim J
        • et al.
        The impact of sex and age on neurological outcomes in out-of-hospital cardiac arrest patients with targeted temperature management.
        Crit Care. 2017; 21: 272
        • Dietz RM
        • Deng G
        • Orfila JE
        • et al.
        Therapeutic hypothermia protects against ischemia-induced impairment of synaptic plasticity following juvenile cardiac arrest in sex-dependent manner.
        Neuroscience. 2016; 325: 132-141
        • Niemann JT
        • Rosborough JP
        • Youngquist S
        Is the tumour necrosis factor-alpha response following resuscitation gender dependent in the swine model?.
        Resuscitation. 2008; 77: 258-263
        • Perers E
        • Abrahamsson P
        • Bang A
        • et al.
        Outcomes of patients hospitalized after out-of-hospital cardiac arrest in relation to sex.
        Coron Artery Dis. 1999; 10: 509-514
        • Greenberg MR
        • Ahnert AM
        • Patel NC
        • et al.
        Sex differences in cardiac arrest survivors who receive therapeutic hypothermia.
        Am J Emerg Med. 2014; 32: 545-548
        • Freund B
        • Kaplan PW
        A review of the utility of a hypothermia protocol in cardiac arrests due to non-shockable rhythms.
        Cardiol J. 2017; 24: 324-333
        • Agarwal S
        • Presciutti A
        • Verma J
        • et al.
        Women have worse cognitive, functional, and psychiatric outcomes at hospital discharge after cardiac arrest.
        Resuscitation. 2018; 125: 12-15
        • Stang A
        Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses.
        Eur J Epidemiol. 2010; 25: 603-605