A1 Vertaisarvioitu alkuperäisartikkeli tieteellisessä lehdessä
Targeted Temperature Management for 48 vs 24 Hours and Neurologic Outcome After Out-of-Hospital Cardiac Arrest A Randomized Clinical Trial
Tekijät: Kirkegaard H, Soreide E, de Haas I, Pettila V, Taccone FS, Arus U, Storm C, Hassager C, Nielsen JF, Sorensen CA, Ilkjaer S, Jeppesen AN, Grejs AM, Duez CHV, Hjort J, Larsen A, Toome V, Tiainen M, Hastbacka J, Laitio T, Skrifvars MB, Skrifvars MB
Kustantaja: AMER MEDICAL ASSOC
Julkaisuvuosi: 2017
Journal: JAMA: Journal of the American Medical Association
Tietokannassa oleva lehden nimi: JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION
Lehden akronyymi: JAMA-J AM MED ASSOC
Vuosikerta: 318
Numero: 4
Aloitussivu: 341
Lopetussivu: 350
Sivujen määrä: 10
ISSN: 0098-7484
DOI: https://doi.org/10.1001/jama.2017.8978
IMPORTANCE International resuscitation guidelines recommend targeted temperature management (TTM) at 33 degrees C to 36 degrees C in unconscious patients with out-of-hospital cardiac arrest for at least 24 hours, but the optimal duration of TTM is uncertain.OBJECTIVE To determine whether TTM at 33 degrees C for 48 hours results in better neurologic outcomes compared with currently recommended, standard, 24-hour TTM.DESIGN, SETTING, AND PARTICIPANTS This was an international, investigator-initiated, blinded-outcome-assessor, parallel, pragmatic, multicenter, randomized clinical superiority trial in 10 intensive care units (ICUs) at 10 university hospitals in 6 European countries. Three hundred fifty-five adult, unconscious patients with out-of-hospital cardiac arrest were enrolled from February 16, 2013, to June 1, 2016, with final follow-up on December 27, 2016.INTERVENTIONS Patients were randomized to TTM(33 +/- 1 degrees C) for 48 hours (n = 176) or 24 hours (n = 179), followed by gradual rewarming of 0.5 degrees C per hour until reaching 37 degrees C.MAIN OUTCOMES AND MEASURES The primary outcome was 6-month neurologic outcome, with a Cerebral Performance Categories (CPC) score of 1 or 2 used to define favorable outcome. Secondary outcomes included 6-month mortality, including time to death, the occurrence of adverse events, and intensive care unit resource use.RESULTS In 355 patients who were randomized (mean age, 60 years; 295 [83%] men), 351 (99%) completed the trial. More patients in the 48-hour group had a favorable outcome, but this was not statistically significant. Six-month mortality was not different between the groups. Adverse events were more common in the 48-hour group than in the 24-hour group. There was no significant difference in the time to mortality (hazard ratio, 0.79; 95% CI, 0.54-1.15; P = .22). The median length of ICU stay (151 vs 117 hours; P < .001), but not hospital stay (11 vs 12 days; P = .50), was longer in the 48-hour group than in the 24-hour group.[GRAPHICS]CONCLUSIONS AND RELEVANCE In unconscious survivors from out-of-hospital cardiac arrest admitted to the ICU, targeted temperature management at 33 degrees C for 48 hours did not significantly improve 6-month neurologic outcome compared with targeted temperature management at 33 degrees C for 24 hours. However, the study may have had limited power to detect clinically important differences, and further research may be warranted.
