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Critical Care
Published in: Critical Care 1/2016

Open Access 01-12-2016 | Research

Intravascular versus surface cooling for targeted temperature management after out-of-hospital cardiac arrest – an analysis of the TTM trial data

Authors: Guy W. Glover, Richard M. Thomas, George Vamvakas, Nawaf Al-Subaie, Jules Cranshaw, Andrew Walden, Matthew P. Wise, Marlies Ostermann, Emma Thomas-Jones, Tobias Cronberg, David Erlinge, Yvan Gasche, Christian Hassager, Janneke Horn, Jesper Kjaergaard, Michael Kuiper, Tommaso Pellis, Pascal Stammet, Michael Wanscher, Jørn Wetterslev, Hans Friberg, Niklas Nielsen

Published in: Critical Care | Issue 1/2016

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Abstract

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 4 hours (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/​NCT01020916NCT01020916; 25 November 2009
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Metadata
Title
Intravascular versus surface cooling for targeted temperature management after out-of-hospital cardiac arrest – an analysis of the TTM trial data
Authors
Guy W. Glover
Richard M. Thomas
George Vamvakas
Nawaf Al-Subaie
Jules Cranshaw
Andrew Walden
Matthew P. Wise
Marlies Ostermann
Emma Thomas-Jones
Tobias Cronberg
David Erlinge
Yvan Gasche
Christian Hassager
Janneke Horn
Jesper Kjaergaard
Michael Kuiper
Tommaso Pellis
Pascal Stammet
Michael Wanscher
Jørn Wetterslev
Hans Friberg
Niklas Nielsen
Publication date
01-12-2016
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2016
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-016-1552-6

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