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Hypothermia versus Normothermia after Out-of-Hospital Cardiac Arrest.
Dankiewicz, Josef; Cronberg, Tobias; Lilja, Gisela; Jakobsen, Janus C; Levin, Helena; Ullén, Susann; Rylander, Christian; Wise, Matt P; Oddo, Mauro; Cariou, Alain; Belohlávek, Jan; Hovdenes, Jan; Saxena, Manoj; Kirkegaard, Hans; Young, Paul J; Pelosi, Paolo; Storm, Christian; Taccone, Fabio S; Joannidis, Michael; Callaway, Clifton; Eastwood, Glenn M; Morgan, Matt P G; Nordberg, Per; Erlinge, David; Nichol, Alistair D; Chew, Michelle S; Hollenberg, Jacob; Thomas, Matthew; Bewley, Jeremy; Sweet, Katie; Grejs, Anders M; Christensen, Steffen; Haenggi, Matthias; Levis, Anja; Lundin, Andreas; Düring, Joachim; Schmidbauer, Simon; Keeble, Thomas R; Karamasis, Grigoris V; Schrag, Claudia; Faessler, Edith; Smid, Ondrej; Otáhal, Michal; Maggiorini, Marco; Wendel Garcia, Pedro D; Jaubert, Paul; Cole, Jade M; Solar, Miroslav; Borgquist, Ola; Leithner, Christoph.
  • Dankiewicz J; From the Department of Clinical Sciences Lund, Sections of Cardiology (J. Dankiewicz, D.E.), Neurology (T. Cronberg, G.L.), and Anesthesiology and Intensive Care (H. Levin, O.B.), Skåne University Hospital Lund, Lund University and Clinical Studies Sweden - Forum South, Skåne University Hospital (S.
  • Cronberg T; From the Department of Clinical Sciences Lund, Sections of Cardiology (J. Dankiewicz, D.E.), Neurology (T. Cronberg, G.L.), and Anesthesiology and Intensive Care (H. Levin, O.B.), Skåne University Hospital Lund, Lund University and Clinical Studies Sweden - Forum South, Skåne University Hospital (S.
  • Lilja G; From the Department of Clinical Sciences Lund, Sections of Cardiology (J. Dankiewicz, D.E.), Neurology (T. Cronberg, G.L.), and Anesthesiology and Intensive Care (H. Levin, O.B.), Skåne University Hospital Lund, Lund University and Clinical Studies Sweden - Forum South, Skåne University Hospital (S.
  • Jakobsen JC; From the Department of Clinical Sciences Lund, Sections of Cardiology (J. Dankiewicz, D.E.), Neurology (T. Cronberg, G.L.), and Anesthesiology and Intensive Care (H. Levin, O.B.), Skåne University Hospital Lund, Lund University and Clinical Studies Sweden - Forum South, Skåne University Hospital (S.
  • Levin H; From the Department of Clinical Sciences Lund, Sections of Cardiology (J. Dankiewicz, D.E.), Neurology (T. Cronberg, G.L.), and Anesthesiology and Intensive Care (H. Levin, O.B.), Skåne University Hospital Lund, Lund University and Clinical Studies Sweden - Forum South, Skåne University Hospital (S.
  • Ullén S; From the Department of Clinical Sciences Lund, Sections of Cardiology (J. Dankiewicz, D.E.), Neurology (T. Cronberg, G.L.), and Anesthesiology and Intensive Care (H. Levin, O.B.), Skåne University Hospital Lund, Lund University and Clinical Studies Sweden - Forum South, Skåne University Hospital (S.
  • Rylander C; From the Department of Clinical Sciences Lund, Sections of Cardiology (J. Dankiewicz, D.E.), Neurology (T. Cronberg, G.L.), and Anesthesiology and Intensive Care (H. Levin, O.B.), Skåne University Hospital Lund, Lund University and Clinical Studies Sweden - Forum South, Skåne University Hospital (S.
  • Wise MP; From the Department of Clinical Sciences Lund, Sections of Cardiology (J. Dankiewicz, D.E.), Neurology (T. Cronberg, G.L.), and Anesthesiology and Intensive Care (H. Levin, O.B.), Skåne University Hospital Lund, Lund University and Clinical Studies Sweden - Forum South, Skåne University Hospital (S.
  • Oddo M; From the Department of Clinical Sciences Lund, Sections of Cardiology (J. Dankiewicz, D.E.), Neurology (T. Cronberg, G.L.), and Anesthesiology and Intensive Care (H. Levin, O.B.), Skåne University Hospital Lund, Lund University and Clinical Studies Sweden - Forum South, Skåne University Hospital (S.
  • Cariou A; From the Department of Clinical Sciences Lund, Sections of Cardiology (J. Dankiewicz, D.E.), Neurology (T. Cronberg, G.L.), and Anesthesiology and Intensive Care (H. Levin, O.B.), Skåne University Hospital Lund, Lund University and Clinical Studies Sweden - Forum South, Skåne University Hospital (S.
  • Belohlávek J; From the Department of Clinical Sciences Lund, Sections of Cardiology (J. Dankiewicz, D.E.), Neurology (T. Cronberg, G.L.), and Anesthesiology and Intensive Care (H. Levin, O.B.), Skåne University Hospital Lund, Lund University and Clinical Studies Sweden - Forum South, Skåne University Hospital (S.
  • Hovdenes J; From the Department of Clinical Sciences Lund, Sections of Cardiology (J. Dankiewicz, D.E.), Neurology (T. Cronberg, G.L.), and Anesthesiology and Intensive Care (H. Levin, O.B.), Skåne University Hospital Lund, Lund University and Clinical Studies Sweden - Forum South, Skåne University Hospital (S.
  • Saxena M; From the Department of Clinical Sciences Lund, Sections of Cardiology (J. Dankiewicz, D.E.), Neurology (T. Cronberg, G.L.), and Anesthesiology and Intensive Care (H. Levin, O.B.), Skåne University Hospital Lund, Lund University and Clinical Studies Sweden - Forum South, Skåne University Hospital (S.
  • Kirkegaard H; From the Department of Clinical Sciences Lund, Sections of Cardiology (J. Dankiewicz, D.E.), Neurology (T. Cronberg, G.L.), and Anesthesiology and Intensive Care (H. Levin, O.B.), Skåne University Hospital Lund, Lund University and Clinical Studies Sweden - Forum South, Skåne University Hospital (S.
  • Young PJ; From the Department of Clinical Sciences Lund, Sections of Cardiology (J. Dankiewicz, D.E.), Neurology (T. Cronberg, G.L.), and Anesthesiology and Intensive Care (H. Levin, O.B.), Skåne University Hospital Lund, Lund University and Clinical Studies Sweden - Forum South, Skåne University Hospital (S.
  • Pelosi P; From the Department of Clinical Sciences Lund, Sections of Cardiology (J. Dankiewicz, D.E.), Neurology (T. Cronberg, G.L.), and Anesthesiology and Intensive Care (H. Levin, O.B.), Skåne University Hospital Lund, Lund University and Clinical Studies Sweden - Forum South, Skåne University Hospital (S.
  • Storm C; From the Department of Clinical Sciences Lund, Sections of Cardiology (J. Dankiewicz, D.E.), Neurology (T. Cronberg, G.L.), and Anesthesiology and Intensive Care (H. Levin, O.B.), Skåne University Hospital Lund, Lund University and Clinical Studies Sweden - Forum South, Skåne University Hospital (S.
  • Taccone FS; From the Department of Clinical Sciences Lund, Sections of Cardiology (J. Dankiewicz, D.E.), Neurology (T. Cronberg, G.L.), and Anesthesiology and Intensive Care (H. Levin, O.B.), Skåne University Hospital Lund, Lund University and Clinical Studies Sweden - Forum South, Skåne University Hospital (S.
  • Joannidis M; From the Department of Clinical Sciences Lund, Sections of Cardiology (J. Dankiewicz, D.E.), Neurology (T. Cronberg, G.L.), and Anesthesiology and Intensive Care (H. Levin, O.B.), Skåne University Hospital Lund, Lund University and Clinical Studies Sweden - Forum South, Skåne University Hospital (S.
  • Callaway C; From the Department of Clinical Sciences Lund, Sections of Cardiology (J. Dankiewicz, D.E.), Neurology (T. Cronberg, G.L.), and Anesthesiology and Intensive Care (H. Levin, O.B.), Skåne University Hospital Lund, Lund University and Clinical Studies Sweden - Forum South, Skåne University Hospital (S.
  • Eastwood GM; From the Department of Clinical Sciences Lund, Sections of Cardiology (J. Dankiewicz, D.E.), Neurology (T. Cronberg, G.L.), and Anesthesiology and Intensive Care (H. Levin, O.B.), Skåne University Hospital Lund, Lund University and Clinical Studies Sweden - Forum South, Skåne University Hospital (S.
  • Morgan MPG; From the Department of Clinical Sciences Lund, Sections of Cardiology (J. Dankiewicz, D.E.), Neurology (T. Cronberg, G.L.), and Anesthesiology and Intensive Care (H. Levin, O.B.), Skåne University Hospital Lund, Lund University and Clinical Studies Sweden - Forum South, Skåne University Hospital (S.
  • Nordberg P; From the Department of Clinical Sciences Lund, Sections of Cardiology (J. Dankiewicz, D.E.), Neurology (T. Cronberg, G.L.), and Anesthesiology and Intensive Care (H. Levin, O.B.), Skåne University Hospital Lund, Lund University and Clinical Studies Sweden - Forum South, Skåne University Hospital (S.
  • Erlinge D; From the Department of Clinical Sciences Lund, Sections of Cardiology (J. Dankiewicz, D.E.), Neurology (T. Cronberg, G.L.), and Anesthesiology and Intensive Care (H. Levin, O.B.), Skåne University Hospital Lund, Lund University and Clinical Studies Sweden - Forum South, Skåne University Hospital (S.
  • Nichol AD; From the Department of Clinical Sciences Lund, Sections of Cardiology (J. Dankiewicz, D.E.), Neurology (T. Cronberg, G.L.), and Anesthesiology and Intensive Care (H. Levin, O.B.), Skåne University Hospital Lund, Lund University and Clinical Studies Sweden - Forum South, Skåne University Hospital (S.
  • Chew MS; From the Department of Clinical Sciences Lund, Sections of Cardiology (J. Dankiewicz, D.E.), Neurology (T. Cronberg, G.L.), and Anesthesiology and Intensive Care (H. Levin, O.B.), Skåne University Hospital Lund, Lund University and Clinical Studies Sweden - Forum South, Skåne University Hospital (S.
  • Hollenberg J; From the Department of Clinical Sciences Lund, Sections of Cardiology (J. Dankiewicz, D.E.), Neurology (T. Cronberg, G.L.), and Anesthesiology and Intensive Care (H. Levin, O.B.), Skåne University Hospital Lund, Lund University and Clinical Studies Sweden - Forum South, Skåne University Hospital (S.
  • Thomas M; From the Department of Clinical Sciences Lund, Sections of Cardiology (J. Dankiewicz, D.E.), Neurology (T. Cronberg, G.L.), and Anesthesiology and Intensive Care (H. Levin, O.B.), Skåne University Hospital Lund, Lund University and Clinical Studies Sweden - Forum South, Skåne University Hospital (S.
  • Bewley J; From the Department of Clinical Sciences Lund, Sections of Cardiology (J. Dankiewicz, D.E.), Neurology (T. Cronberg, G.L.), and Anesthesiology and Intensive Care (H. Levin, O.B.), Skåne University Hospital Lund, Lund University and Clinical Studies Sweden - Forum South, Skåne University Hospital (S.
  • Sweet K; From the Department of Clinical Sciences Lund, Sections of Cardiology (J. Dankiewicz, D.E.), Neurology (T. Cronberg, G.L.), and Anesthesiology and Intensive Care (H. Levin, O.B.), Skåne University Hospital Lund, Lund University and Clinical Studies Sweden - Forum South, Skåne University Hospital (S.
  • Grejs AM; From the Department of Clinical Sciences Lund, Sections of Cardiology (J. Dankiewicz, D.E.), Neurology (T. Cronberg, G.L.), and Anesthesiology and Intensive Care (H. Levin, O.B.), Skåne University Hospital Lund, Lund University and Clinical Studies Sweden - Forum South, Skåne University Hospital (S.
  • Christensen S; From the Department of Clinical Sciences Lund, Sections of Cardiology (J. Dankiewicz, D.E.), Neurology (T. Cronberg, G.L.), and Anesthesiology and Intensive Care (H. Levin, O.B.), Skåne University Hospital Lund, Lund University and Clinical Studies Sweden - Forum South, Skåne University Hospital (S.
  • Haenggi M; From the Department of Clinical Sciences Lund, Sections of Cardiology (J. Dankiewicz, D.E.), Neurology (T. Cronberg, G.L.), and Anesthesiology and Intensive Care (H. Levin, O.B.), Skåne University Hospital Lund, Lund University and Clinical Studies Sweden - Forum South, Skåne University Hospital (S.
  • Levis A; From the Department of Clinical Sciences Lund, Sections of Cardiology (J. Dankiewicz, D.E.), Neurology (T. Cronberg, G.L.), and Anesthesiology and Intensive Care (H. Levin, O.B.), Skåne University Hospital Lund, Lund University and Clinical Studies Sweden - Forum South, Skåne University Hospital (S.
  • Lundin A; From the Department of Clinical Sciences Lund, Sections of Cardiology (J. Dankiewicz, D.E.), Neurology (T. Cronberg, G.L.), and Anesthesiology and Intensive Care (H. Levin, O.B.), Skåne University Hospital Lund, Lund University and Clinical Studies Sweden - Forum South, Skåne University Hospital (S.
  • Düring J; From the Department of Clinical Sciences Lund, Sections of Cardiology (J. Dankiewicz, D.E.), Neurology (T. Cronberg, G.L.), and Anesthesiology and Intensive Care (H. Levin, O.B.), Skåne University Hospital Lund, Lund University and Clinical Studies Sweden - Forum South, Skåne University Hospital (S.
  • Schmidbauer S; From the Department of Clinical Sciences Lund, Sections of Cardiology (J. Dankiewicz, D.E.), Neurology (T. Cronberg, G.L.), and Anesthesiology and Intensive Care (H. Levin, O.B.), Skåne University Hospital Lund, Lund University and Clinical Studies Sweden - Forum South, Skåne University Hospital (S.
  • Keeble TR; From the Department of Clinical Sciences Lund, Sections of Cardiology (J. Dankiewicz, D.E.), Neurology (T. Cronberg, G.L.), and Anesthesiology and Intensive Care (H. Levin, O.B.), Skåne University Hospital Lund, Lund University and Clinical Studies Sweden - Forum South, Skåne University Hospital (S.
  • Karamasis GV; From the Department of Clinical Sciences Lund, Sections of Cardiology (J. Dankiewicz, D.E.), Neurology (T. Cronberg, G.L.), and Anesthesiology and Intensive Care (H. Levin, O.B.), Skåne University Hospital Lund, Lund University and Clinical Studies Sweden - Forum South, Skåne University Hospital (S.
  • Schrag C; From the Department of Clinical Sciences Lund, Sections of Cardiology (J. Dankiewicz, D.E.), Neurology (T. Cronberg, G.L.), and Anesthesiology and Intensive Care (H. Levin, O.B.), Skåne University Hospital Lund, Lund University and Clinical Studies Sweden - Forum South, Skåne University Hospital (S.
  • Faessler E; From the Department of Clinical Sciences Lund, Sections of Cardiology (J. Dankiewicz, D.E.), Neurology (T. Cronberg, G.L.), and Anesthesiology and Intensive Care (H. Levin, O.B.), Skåne University Hospital Lund, Lund University and Clinical Studies Sweden - Forum South, Skåne University Hospital (S.
  • Smid O; From the Department of Clinical Sciences Lund, Sections of Cardiology (J. Dankiewicz, D.E.), Neurology (T. Cronberg, G.L.), and Anesthesiology and Intensive Care (H. Levin, O.B.), Skåne University Hospital Lund, Lund University and Clinical Studies Sweden - Forum South, Skåne University Hospital (S.
  • Otáhal M; From the Department of Clinical Sciences Lund, Sections of Cardiology (J. Dankiewicz, D.E.), Neurology (T. Cronberg, G.L.), and Anesthesiology and Intensive Care (H. Levin, O.B.), Skåne University Hospital Lund, Lund University and Clinical Studies Sweden - Forum South, Skåne University Hospital (S.
  • Maggiorini M; From the Department of Clinical Sciences Lund, Sections of Cardiology (J. Dankiewicz, D.E.), Neurology (T. Cronberg, G.L.), and Anesthesiology and Intensive Care (H. Levin, O.B.), Skåne University Hospital Lund, Lund University and Clinical Studies Sweden - Forum South, Skåne University Hospital (S.
  • Wendel Garcia PD; From the Department of Clinical Sciences Lund, Sections of Cardiology (J. Dankiewicz, D.E.), Neurology (T. Cronberg, G.L.), and Anesthesiology and Intensive Care (H. Levin, O.B.), Skåne University Hospital Lund, Lund University and Clinical Studies Sweden - Forum South, Skåne University Hospital (S.
  • Jaubert P; From the Department of Clinical Sciences Lund, Sections of Cardiology (J. Dankiewicz, D.E.), Neurology (T. Cronberg, G.L.), and Anesthesiology and Intensive Care (H. Levin, O.B.), Skåne University Hospital Lund, Lund University and Clinical Studies Sweden - Forum South, Skåne University Hospital (S.
  • Cole JM; From the Department of Clinical Sciences Lund, Sections of Cardiology (J. Dankiewicz, D.E.), Neurology (T. Cronberg, G.L.), and Anesthesiology and Intensive Care (H. Levin, O.B.), Skåne University Hospital Lund, Lund University and Clinical Studies Sweden - Forum South, Skåne University Hospital (S.
  • Solar M; From the Department of Clinical Sciences Lund, Sections of Cardiology (J. Dankiewicz, D.E.), Neurology (T. Cronberg, G.L.), and Anesthesiology and Intensive Care (H. Levin, O.B.), Skåne University Hospital Lund, Lund University and Clinical Studies Sweden - Forum South, Skåne University Hospital (S.
  • Borgquist O; From the Department of Clinical Sciences Lund, Sections of Cardiology (J. Dankiewicz, D.E.), Neurology (T. Cronberg, G.L.), and Anesthesiology and Intensive Care (H. Levin, O.B.), Skåne University Hospital Lund, Lund University and Clinical Studies Sweden - Forum South, Skåne University Hospital (S.
  • Leithner C; From the Department of Clinical Sciences Lund, Sections of Cardiology (J. Dankiewicz, D.E.), Neurology (T. Cronberg, G.L.), and Anesthesiology and Intensive Care (H. Levin, O.B.), Skåne University Hospital Lund, Lund University and Clinical Studies Sweden - Forum South, Skåne University Hospital (S.
N Engl J Med ; 384(24): 2283-2294, 2021 06 17.
Article in English | MEDLINE | ID: covidwho-1275997
Semantic information from SemMedBD (by NLM)
1. Heart LOCATION_OF Out-of-Hospital Cardiac Arrest
Subject
Heart
Predicate
LOCATION_OF
Object
Out-of-Hospital Cardiac Arrest
2. Out-of-Hospital Cardiac Arrest PROCESS_OF Adult
Subject
Out-of-Hospital Cardiac Arrest
Predicate
PROCESS_OF
Object
Adult
3. Comatose PROCESS_OF Adult
Subject
Comatose
Predicate
PROCESS_OF
Object
Adult
4. Rewarming TREATS Fever
Subject
Rewarming
Predicate
TREATS
Object
Fever
5. Heart LOCATION_OF Rhythm
Subject
Heart
Predicate
LOCATION_OF
Object
Rhythm
6. Disability PROCESS_OF Patients
Subject
Disability
Predicate
PROCESS_OF
Object
Patients
7. Comatose PROCESS_OF Patients
Subject
Comatose
Predicate
PROCESS_OF
Object
Patients
8. Heart LOCATION_OF Out-of-Hospital Cardiac Arrest
Subject
Heart
Predicate
LOCATION_OF
Object
Out-of-Hospital Cardiac Arrest
9. Out-of-Hospital Cardiac Arrest PROCESS_OF Adult
Subject
Out-of-Hospital Cardiac Arrest
Predicate
PROCESS_OF
Object
Adult
10. Comatose PROCESS_OF Adult
Subject
Comatose
Predicate
PROCESS_OF
Object
Adult
11. Rewarming TREATS Fever
Subject
Rewarming
Predicate
TREATS
Object
Fever
12. Heart LOCATION_OF Rhythm
Subject
Heart
Predicate
LOCATION_OF
Object
Rhythm
13. Disability PROCESS_OF Patients
Subject
Disability
Predicate
PROCESS_OF
Object
Patients
14. Comatose PROCESS_OF Patients
Subject
Comatose
Predicate
PROCESS_OF
Object
Patients
ABSTRACT

BACKGROUND:

Targeted temperature management is recommended for patients after cardiac arrest, but the supporting evidence is of low certainty.

METHODS:

In an open-label trial with blinded assessment of outcomes, we randomly assigned 1900 adults with coma who had had an out-of-hospital cardiac arrest of presumed cardiac or unknown cause to undergo targeted hypothermia at 33°C, followed by controlled rewarming, or targeted normothermia with early treatment of fever (body temperature, ≥37.8°C). The primary outcome was death from any cause at 6 months. Secondary outcomes included functional outcome at 6 months as assessed with the modified Rankin scale. Prespecified subgroups were defined according to sex, age, initial cardiac rhythm, time to return of spontaneous circulation, and presence or absence of shock on admission. Prespecified adverse events were pneumonia, sepsis, bleeding, arrhythmia resulting in hemodynamic compromise, and skin complications related to the temperature management device.

RESULTS:

A total of 1850 patients were evaluated for the primary outcome. At 6 months, 465 of 925 patients (50%) in the hypothermia group had died, as compared with 446 of 925 (48%) in the normothermia group (relative risk with hypothermia, 1.04; 95% confidence interval [CI], 0.94 to 1.14; P = 0.37). Of the 1747 patients in whom the functional outcome was assessed, 488 of 881 (55%) in the hypothermia group had moderately severe disability or worse (modified Rankin scale score ≥4), as compared with 479 of 866 (55%) in the normothermia group (relative risk with hypothermia, 1.00; 95% CI, 0.92 to 1.09). Outcomes were consistent in the prespecified subgroups. Arrhythmia resulting in hemodynamic compromise was more common in the hypothermia group than in the normothermia group (24% vs. 17%, P<0.001). The incidence of other adverse events did not differ significantly between the two groups.

CONCLUSIONS:

In patients with coma after out-of-hospital cardiac arrest, targeted hypothermia did not lead to a lower incidence of death by 6 months than targeted normothermia. (Funded by the Swedish Research Council and others; TTM2 ClinicalTrials.gov number, NCT02908308.).
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Out-of-Hospital Cardiac Arrest / Fever / Hypothermia, Induced Type of study: Controlled clinical trial / Etiology study / Randomized controlled trials Topics: Long Covid Limits: Aged / Female / Humans / Male / Middle aged Language: English Journal: N Engl J Med Year: 2021 Document Type: Article

Full text: Available Collection: International databases Database: MEDLINE Main subject: Out-of-Hospital Cardiac Arrest / Fever / Hypothermia, Induced Type of study: Controlled clinical trial / Etiology study / Randomized controlled trials Topics: Long Covid Limits: Aged / Female / Humans / Male / Middle aged Language: English Journal: N Engl J Med Year: 2021 Document Type: Article