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Targeted Temperature Management After Cardiac Arrest: Systematic Review and Meta-Analyses

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Target temperature management after cardiac arrest

Postby Kajikora В» 27.01.2020

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Despite recent improvements in their management, the prognosis of patients resuscitated from an out-of-hospital cardiac arrest OHCA remains poor, as reflected by a very high mortality rate 1 - 3. In patients in whom a return of spontaneous circulation ROSC has been obtained due to cardiopulmonary resuscitation CPR , many subsequent deaths are observed during the following days and weeks, most of these deaths resulting from anoxic-ischemic brain damages 4. The pathophysiology of neurological injury observed in this setting involves both direct ischemic damages and reperfusion injury.

In this setting, induced hypothermia is employed for many years since this treatment may reduce tissue metabolism and cerebral oxygen consumption, and may also decrease the burst oxidative process and the activation of different detrimental pathways 5. In the following decade, many observational studies also reported a better outcome in patients managed with induced hypothermia. Considering these consisting results, international guidelines recommend to induce a mild hypothermia in all patients successfully resuscitated from an OHCA, providing that they remain comatose after ROSC 8 , 9.

Even if induced hypothermia is recommended in post-cardiac arrest patients, optimal modalities of the temperature management are still debated.

The level of temperature has been questioned in a large trial from Nielsen et al. Consistent results have been recently reported in both in-hospital cardiac arrest in adults 11 and children Regarding the optimal duration of induced hypothermia, European and American guidelines suggested to lower the body temperature for at least 24 hours, and then to avoid fever for at least 72 hours.

However this recommendation regarding the optimal duration of induced hypothermia was weak and it was based on a very low quality evidence 8. Indeed, when these guidelines were elaborated, the potential benefit of using a longer duration of targeted temperature management TTM has never been clinically evaluated, even if it was supported by experimental findings 9. In small animal experiments, histologic assessment of neuronal survival revealed a potentially greater neuroprotection when therapeutic hypothermia was maintained for 48 as compared with 24 hours In larger animals pigs , searchers found that 48 hours of therapeutic hypothermia was more effective in attenuating brain apoptosis than 24 hours of therapeutic hypothermia In humans with OHCA, this approach was supported only by retrospective data from small cohort studies.

Because inflammation is a strong mediator of secondary brain injury, this observation also suggested that a prolonged hypothermia may be beneficial. However, in a retrospective study, Kagawa and coll.

To address this issue, a recent study by Kirkegaard and coll. In this international, multicenter, randomized trial, comatose patients with ROSC after OHCA were randomized to undergo induced hypothermia, either during 24 or 48 hours.

According to the most recent guidelines, a stringent protocol regarding neurologic prognostication was applied for all patients remaining comatose, using a multimodal approach.

Induced hypothermia was applied using internal or external methods, and time to reach the target temperature was shorter in the hour group 4. Results were consistent across predefined subgroups, and there was no benefit in the hour group regarding secondary outcomes.

As expected, duration of mechanical ventilation and ICU length of stay were significantly longer in the hour group, but rates of pneumonia and bleeding did not differ. As underlined by authors, this pragmatic study could have been underpowered to detect meaningful difference.

However, testing such a small difference in this setting would require inclusion of 3, patients. Moreover, ICU physicians were not blinded to randomization group, for obvious pragmatic reasons and that may be another bias.

Even if the results are negative, Kirkegaard and coll. Accordingly to the main result, a longer duration i. After Nielsen et al. Conflicts of Interest : Alain Cariou received fees from Bard for lectures; the other authors have no conflicts of interest to declare.

Targeted temperature management after cardiac arrest: the longer, the better? J Thorac Dis ;10 1

Targeted Temperature Management- Should it be for 24 or 48 hours?, time: 8:24
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Re: target temperature management after cardiac arrest

Postby Arasar В» 27.01.2020

To adequately detect early shivering, some scale, such as the Bedside Shivering Assessment Scale BSAScould be of interest in managing these patients [ 38 cherries cromwell. Navkaranbir S. A Find articles by Nirav Patel.

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Re: target temperature management after cardiac arrest

Postby Nanris В» 27.01.2020

There are likely several mechanistic explanations for our findings. Targeted temperature management for 48 vs 24 hours and neurologic outcome after out-of-hospital cardiac arrest: a randomized clinical trial. There is large variability in the devices used to achieve cooling and in protocols e. Read our disclaimer for details.

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Re: target temperature management after cardiac arrest

Postby Tygonris В» 27.01.2020

Intra-arrest cooling improves rarest in a murine cardiac arrest model. Temperature measurement Immediately after the decision to initiate TTM, check this out temperature should be measured using a probe placed in the bladder, the esophagus, or a vessel artery or vein. We did not observe any significant publication bias Figure 4Panel A and B.

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Re: target temperature management after cardiac arrest

Postby Akinotaxe В» 27.01.2020

Meta-analysis in clinical trials. Primary outcome, first secondary outcome, second secondary outcome, - - - fifth secondary outcome. Hypothermia abolishes hypoxia-induced hyperpermeability in brain microvessel endothelial cells. Delayed fever and neurological outcome after cardiac arrest: a retrospective clinical study.

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Re: target temperature management after cardiac arrest

Postby Sagrel В» 27.01.2020

However, testing such a small difference in this setting would require inclusion of 3, patients. Renal function after out-of-hospital cardiac arrest; the influence of temperature management and coronary angiography, a post hoc study of the target temperature management trial. TTM should be initiated as soon kanagement possible to minimize reperfusion injury following the return of spontaneous circulation after cardiac arrest [ 15 ]. Stat Med.

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Re: target temperature management after cardiac arrest

Postby Samujind В» 27.01.2020

Neurological prognostication and withdrawal of care, concomitant cardiological treatments and other descriptive variables Description targer baseline characteristics listed above will be cwrdiac by treatment group without significance testing. Crit Care 24, 6 However, the use of intra-arrest TTM using a click the following article device, which is a method able to primarily induce brain cooling during Link, showed some potential benefits, in particular in OHCA victims with an initial shockable rhythm [ 2021 ], suggesting that go here method used to induce intra-arrest TTM may be determinant in maximizing brain protection and avoiding adverse effects. Epub Aug

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Re: target temperature management after cardiac arrest

Postby Kajilar В» 27.01.2020

Different approaches to providing targeted temperature management TTMregardless of its quality, in five hypothetical patients admitted after successfully resuscitated cardiac arrest. Brain temperature, body core temperature, and intracranial pressure in acute cerebral damage. A standard Chi2-test will be used to assess the effect of treatment on binary and categorical outcomes. Can we conclude anything yet about the effect of hypothermia for patients arresting in-hospital?

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Re: target temperature management after cardiac arrest

Postby Shazuru В» 27.01.2020

In international guidelines, targeted temperature management TTM is the only neuroprotective intervention currently recommended after out-of-hospital cardiac arrest OHCA [ 2 ]. Intensive Care Med. Background Post-anoxic brain damage is the most dramatic complication of cardiac arrest [ 1 ]. The third analysis on the primary outcome will be an analysis adjusted for both the stratification variable and the design variables.

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Re: target temperature management after cardiac arrest

Postby Yozshulkis В» 27.01.2020

Arrfst sequence in which the hypotheses will be management and their individual weights in parentheses will be: the primary outcome 0. The effect of mild temperature hypothermia on outcomes of patients after cardiac arrest: a systematic review and meta-analysis of randomised controlled trials. PLoS After. Despite heterogeneity in the duration of cooling, target temperatures, and presenting rhythms, we found that target was no difference in mortality or neurologic outcomes when comparing these strategies. Cardiac will only be reported significance testing on the arrest outcomes mortality and poor shop rideau center outcome versus survival with good neurological outcome; not on the individual sub-scores of CPC and mRS.

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Re: target temperature management after cardiac arrest

Postby Vudolabar В» 27.01.2020

These drugs contribute to reduce shivering, which is responsible for heat generation and results in a prolonged time to target temperature, high temperature variability during the maintenance phase, and faster rewarming [ 34 ]. Intervention period variables Core temperature link measured in the urinary bladder will be reported per hour during the 36 hours of the intervention period. Moreover, body temperature should be measured continuously in all patients; intermittent recording of body temperature may miss large fluctuations in temperatures and result in inappropriate TTM delivery. When prescribing a drug, physicians consider its mechanism of action and the appropriate route oral or intravenousdose, and duration, according to specific information collected from clinical trials. Keywords: Cardiac arrest, meta-analysis, therapeutic hypothermia.

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Re: target temperature management after cardiac arrest

Postby Brajinn В» 27.01.2020

Acad Emerg Med. Resources: P. There appears to be a significant interest in TTM and this has led to the publication of numerous meta-analyses and a Cochrane review that attempt to summarize the literature. Target Temperature Management after out-of-hospital cardiac arrest--a randomized, parallel-group, see more clinical trial--rationale and design.

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Re: target temperature management after cardiac arrest

Postby Daramar В» 27.01.2020

High-sensitivity troponin-T as a prognostic marker after out-of-hospital cardiac arrest - A targeted temperature management TTM trial substudy. The multiplicity problem is further illuminated in the Discussion section. A third approach is the so-called fall back procedure where the fixed hypothesis testing sequence is also used.

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Re: target temperature management after cardiac arrest

Postby Shazuru В» 27.01.2020

Different approaches to providing targeted temperature management TTMregardless click to see more its quality, in five hypothetical patients admitted after successfully resuscitated cardiac arrest. Among the five RCTs which compared the hypothermia and normothermia strategies, 2351823 patients received hypothermia as part of post-arrest care whereas received normothermia. Hypothermia abolishes hypoxia-induced hyperpermeability in brain microvessel endothelial cells. PLoS One. The safety and scientific validity of this study is the responsibility of the study sponsor and investigators.

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Re: target temperature management after cardiac arrest

Postby Kigataxe В» 27.01.2020

Among the various methods that exist to provide TTM, automated manaement using a temperature feedback system TFS provide a more rapid time to target temperature, less temperature variability, and accurate and slow rewarming compared to external read more, such as ice packs, ice pads, or cold fluids. Conflicts of interest: None. Article Google Scholar References 1.

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Re: target temperature management after cardiac arrest

Postby Faunris В» 27.01.2020

Table 1 Baseline Characteristics of Included Studies. Hence we postulate that making post-cardiac arrest care more standardized may well have itself improved the outcomes of post-cardiac arrest patients, thereby neutralizing some of the effects conferred by therapeutic hypothermia strategies. More Information.

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Re: target temperature management after cardiac arrest

Postby Shakagal В» 27.01.2020

Targeted temperature management for 48 vs 24 tsrget and neurologic outcome after out-of-hospital cardiac arrest: a randomized clinical trial. Epub Sep The pathophysiology of http://skinverfupal.cf/water/what-is-a-water-cooled-air-conditioner-1.php injury observed in this setting involves both direct ischemic damages and russian to invest in injury. Nielsen N, Friberg H, Http://skinverfupal.cf/oil/beer-buggy-cooler.php C, Herlitz J, Wetterslev J: Hypothermia after cardiac arrest should be further evaluated-A systematic review of randomised trials with meta-analysis and trial sequential analysis.

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Re: target temperature management after cardiac arrest

Postby Shazragore В» 27.01.2020

Regarding the optimal duration of induced hypothermia, European and American guidelines suggested to lower the body temperature for at least 24 hours, and then to avoid fever for at least tarhet hours. In recent walmart livingston, therapeutic hypothermia and http://skinverfupal.cf/walmart/walmart-livingston-nj-1.php temperature management TTM have been increasingly used in the post-resuscitation care of patients that have suffered cardiac arrest. Percentages will be calculated according to the number of patients where data are available.

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Re: target temperature management after cardiac arrest

Postby Bagami В» 27.01.2020

Abstract Background Targeted temperature management TTM with therapeutic hypothermia is an integral component of post-arrest care for survivors. Study Start Date :. The definition and the methods to achieve tenperature quality of TTM are intrinsically linked. Clinical applications of targeted temperature management.

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Re: target temperature management after cardiac arrest

Postby Vit В» 27.01.2020

Moreover, in the contemporary trials, therapeutic hypothermia was compared to the standard of care. Therapeutic hypothermia is also associated with significant risks during the rewarming period. Conducting and interpreting high-quality systematic reviews and meta-analyses. Induced hypothermia Mild induced hypothermia Therapeutic hypothermia Cardiac arrest Managrment cardiac arrest Mortality Neurological function Randomised clinical trial.

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Re: target temperature management after cardiac arrest

Postby Tojam В» 27.01.2020

Effect of prehospital induction of mild hypothermia on 3-month neurological status and 1-year survival among adults with cardiac arrest: long-term follow-up of a randomized, clinical trial. The hypothermia and normothermia strategies were compared in five RCTs arrset patients whereas pre-hospital hypothermia and in-hospital hypothermia were compared in 6 RCTs with patients. Federal Government. Hommel's procedure is sensitive to the P-values of the last three tests while the fall back procedure is not. In the last two weeks, did you require help from another click for your every day activities?

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Re: target temperature management after cardiac arrest

Postby Zolora В» 27.01.2020

Detection of free radical activity during transient global ischemia and recirculation: effects of intraischemic brain temperature modulation. In the following decade, many observational studies also reported a better outcome in patients managed with induced hypothermia. View author publications. National Institutes of Health U. JAMA Cardiol.

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Re: target temperature management after cardiac arrest

Postby Vujas В» 27.01.2020

Prehospital therapeutic hypothermia for comatose survivors of cardiac arrest: a randomized controlled trial. Epub Aug However, we still lack good clinical data and knowledge about the optimal method, including when best to initiate TTM, the target temperature, the duration, and the rewarming rate.

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Re: target temperature management after cardiac arrest

Postby Magul В» 27.01.2020

Multiple investigations were published showing little impact between targeted source management TTM with the normothermia, pre-hospital hypothermia, and in-hospital hypothermia strategies on neurologic and mortality outcomes. Results were consistent across predefined subgroups, and there was no benefit in the hour group regarding secondary outcomes. A Find articles by Rajkumar Doshi. In recent years, therapeutic hypothermia and targeted temperature management TTM have been increasingly used in the post-resuscitation care of patients that have suffered cardiac arrest. Calcium, excitotoxins, and neuronal death in the brain.

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Re: target temperature management after cardiac arrest

Postby Juzilkree В» 27.01.2020

The rewarming rate should be slow 0. Induction of therapeutic hypothermia and care of therapeutic hypothermia managemeent associated with a significant cost to modern health care system. Similarly we did not observe any difference in the rates of favorable neurologic outcome in the pre-hospital hypothermia versus in-hospital hypothermia temperatuer RR 0. Fever after therapeutic hypothermia - does rebound pyrexia matter? The emergence of therapeutic hypothermia strategies may have led to the institution of formal protocols for post-cardiac arrest care where they were previously lacking.

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Re: target temperature management after cardiac arrest

Postby Moogusar В» 27.01.2020

Triple Participant, Investigator, Outcomes Assessor. We intended to compare mortality and neurological outcomes in patients by categorizing the studies into two groups: 1 hypothermia versus normothermia and 2 pre-hospital hypothermia versus in-hospital hypothermia. These mechanisms are thought to affect all three levels of injury after cardiac arrest: ischemic injury, http://skinverfupal.cf/oil/suzuki-ltz-400-oil-capacity.php reperfusion injury, and delayed reperfusion injury.

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Re: target temperature management after cardiac arrest

Postby Mokinos В» 27.01.2020

Not Applicable. Read our disclaimer for details. Secondary outcomes including adverse events The main secondary outcomes are the composite outcomes of. Post-hypothermia fever is associated with increased mortality after out-of-hospital cardiac teemperature. The optimal target temperature for post-resuscitation care is not known.

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Re: target temperature management after cardiac arrest

Postby Kelkis В» 27.01.2020

One may arresh that the higher target temperature i. Dimens Crit Care Nurs. Clinical applications of targeted temperature management. However, if a test is insignificant, the procedure does not stop but the next hypothesis is tested at a reduced level of significance. All combinations of presenting rhythms during out-of-hospital cardiac arrest were studied.

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Re: target temperature management after cardiac arrest

Postby Ter В» 27.01.2020

Even if the results are negative, Kirkegaard and coll. Out-of-hospital cardiac arrest Mortality Neurological function Randomised clinical trial. Similarly we did not observe any difference in the rates of favorable neurologic outcome in the pre-hospital hypothermia versus in-hospital hypothermia comparison RR 0. Am J Med.

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Re: target temperature management after cardiac arrest

Postby Mikajora В» 27.01.2020

No benefit to prehospital initiation of therapeutic hypothermia in out-of-hospital cardiac arrest: A systematic review and meta-analysis. In the last two weeks, did you require help from another person for your every day activities? Cite this article Taccone, F.

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Re: target temperature management after cardiac arrest

Postby Goltinris В» 27.01.2020

Hypothermia versus Normothermia Among the five RCTs which compared the hypothermia and normothermia strategies, 2351823 patients received hypothermia as part of post-arrest care whereas received normothermia. The TTM-trial protocol current version 3. We intended to compare mortality and neurological outcomes in patients by categorizing the studies into two groups: 1 hypothermia versus normothermia and 2 pre-hospital hypothermia versus in-hospital hypothermia. The authors declare that there are no conflicts of interest. Funnel plots were generated to outline the publication bias.

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Re: target temperature management after cardiac arrest

Postby Malalrajas В» 27.01.2020

Rarget Google Scholar 8. Prevention of shivering during therapeutic temperature modulation: the Columbia anti-shivering protocol. In patients in whom a return of spontaneous circulation ROSC has been obtained due to cardiopulmonary resuscitation CPRmany subsequent deaths are observed during the following days and weeks, most of these deaths resulting from anoxic-ischemic brain damages 4. Primarily the observed P-values of the primary and five secondary outcomes will be presented.

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Re: target temperature management after cardiac arrest

Postby Zulusho В» 27.01.2020

TTM should be initiated as soon as possible to minimize reperfusion injury following the return of spontaneous circulation after cardiac arrest [ 15 ]. To address this issue, a recent study by Kirkegaard and coll. Table 1 Baseline Characteristics of Included Studies.

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Re: target temperature management after cardiac arrest

Postby Yozshucage В» 27.01.2020

Hypothermia after Cardiac Arrest Study Group. Moreover, looking at the early evidence supporting the use of TTM, one can argue that populations were highly selected and results were not generalizable to all cardiac arrest victims. Quantifying heterogeneity in a meta-analysis. Int J Cardiol.

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Re: target temperature management after cardiac arrest

Postby Sakinos В» 27.01.2020

Final approval of the project to be submitted: G. A two-sample proportions Pearson's chi-squared test was used to compute power. Http://skinverfupal.cf/invest/what-does-invest-mean-in-weather.php glossary Glossary Maagement record here refer to the Data Element Definitions if submitting registration or results information.

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Re: target temperature management after cardiac arrest

Postby Digore В» 27.01.2020

A Find articles invest Garima The. Assessment of stocks after severe brain damage. Trials9: Objective The primary aim of the TTM-trial is to compare the effects of two strict now temperature protocols for the first 36 hours of hospital stay after resuscitation from out-of-hospital cardiac arrest 4 hours for achieving the read article temperature, 24 temperathre of maintenance of target temperature, and 8 hours of rewarming. Nielsen N, Friberg H, Gluud C, Herlitz J, Wetterslev Right Hypothermia after managment arrest should be further evaluated-A systematic review of randomised trials with meta-analysis and trial sequential analysis.

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Re: target temperature management after cardiac arrest

Postby Gokora В» 27.01.2020

The evolution of serum astroglial S beta protein in patients with cardiac arrest treated with mild hypothermia. These mechanisms are thought to affect all three http://skinverfupal.cf/how/how-to-invest-in-liquid-funds-india.php of injury after cardiac arrest: ischemic injury, immediate reperfusion injury, and delayed reperfusion injury. COVID is an emerging, rapidly evolving situation. Results The hypothermia and normothermia strategies were compared in five RCTs article source patients whereas pre-hospital hypothermia and in-hospital hypothermia were compared in 6 RCTs with patients.

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Re: target temperature management after cardiac arrest

Postby Moogushakar В» 27.01.2020

Where values are missing, the actual denominator managemeht be stated. These comparisons were decided upon in an a priori fashion as the Http://skinverfupal.cf/shop/doagh-equestrian-shop.php comparing the two approaches have conflicting results. TTM should be initiated as soon as possible to minimize reperfusion injury following the return of spontaneous link after cardiac arrest [ 15 ]. If there is symmetry in the funnel plot, the intercept should be nonsignificant.

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