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Review
.2018 Mar 13;22(1):66.
doi: 10.1186/s13054-018-1984-2.

The efficacy and safety of pre-hospital cooling after out-of-hospital cardiac arrest: a systematic review and meta-analysis

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Review

The efficacy and safety of pre-hospital cooling after out-of-hospital cardiac arrest: a systematic review and meta-analysis

Patrick J Lindsay et al. Crit Care..

Abstract

Background: Mild therapeutic hypothermia (TH), or targeted temperature management, improves survival and neurological outcomes in patients after out-of-hospital cardiac arrest (OHCA). International guidelines strongly support initiating TH for all eligible individuals presenting with OHCA; however, the timing of cooling initiation remains uncertain. This systematic review and meta-analysis was conducted with all available randomised controlled trials (RCTs) included to explore the efficacy and safety of initiating pre-hospital TH in patients with OHCA.

Methods: The MEDLINE and Cochrane databases were searched from inception to October 2017. Inclusion criteria for full-text review included RCTs comparing pre-hospital TH with no pre-hospital TH after cardiac arrest, patients > 14 years of age with documented cardiac arrest from any rhythm, and outcome data that included survival to hospital discharge and temperature at hospital arrival. Results of retrieved studies were compared through meta-analysis using random effects modelling.

Results: A total of 10 trials comprising 4220 patients were included. There were no significant differences between the two arms for the primary outcome of neurological recovery (risk ratio [RR] 1.04, 95% CI 0.93-1.15) or the secondary outcome of survival to hospital discharge (RR 1.01, 95% CI 0.92-1.11). However, there was a significantly lower temperature at hospital arrival in patients receiving pre-hospital TH (mean difference - 0.83, 95% CI - 1.03 to - 0.63). Pre-hospital TH significantly increased the risk of re-arrest (RR 1.19, 95% CI 1.00 to 1.41). No survival differences were observed among subgroups of patients who received intra-arrest TH vs post-arrest TH or who had shockable vs non-shockable rhythms.

Conclusions: Pre-hospital TH after OHCA effectively decreases body temperature at the time of hospital arrival. However, it does not improve rates of survival with good neurological outcome or overall survival and is associated with increased rates of re-arrest.

Keywords: Cooling; Out-of-hospital cardiac arrest; Pre-hospital; Therapeutic hypothermia.

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Not applicable.

Competing interests

The authors declare that they have no competing interests.

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Figures

Fig. 1
Fig. 1
Flow diagram of study selection
Fig. 2
Fig. 2
Risk ratio of favourable neurological outcome.M-H Mantel-Haenszel method,TH Therapeutic hypothermia
Fig. 3
Fig. 3
Risk ratio of survival at discharge.M-H Mantel-Haenszel method,TH Therapeutic hypothermia
Fig. 4
Fig. 4
Mean temperature difference upon hospital arrival.TH Therapeutic hypothermia
Fig. 5
Fig. 5
Risk ratio of re-arrest.M-H Mantel-Haenszel method,TH Therapeutic hypothermia
See this image and copyright information in PMC

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