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30.06.2020 | Original Work

Induced Hypothermia in Patients with Cardiac Arrest and a Non-shockable Rhythm: Meta-analysis and Trial Sequential Analysis

verfasst von: Mohammed Osman, Muhammad Bilal Munir, Sean Regner, Khansa Osman, Mina M. Benjamin, Babikir Kheiri, Pratik Agrawal, Paul McCarthy, Sudarshan Balla, Christopher M. Bianco

Erschienen in: Neurocritical Care | Ausgabe 1/2021

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Abstract

Background

Controversy surrounds utilization of induced hypothermia (IHT) in comatose cardiac arrest (CA) survivors with a non-shockable rhythm.

Methods

We conducted a meta-analysis and trial sequential analysis (TSA) comparing IHT with no IHT approaches in patients with CA and a non-shockable rhythm. The primary outcome of interest was favorable neurological outcomes (FNO) defined using the Cerebral Performance Category (CPC) score of 1 or 2. Secondary endpoints were survival at discharge and survival beyond 90 days.

Results

A total of 9 studies with 10,386 patients were included. There was no difference between both groups in terms of FNO (13% vs. 13%, RR 1.34, 95% CI 0.96–1.89, p = 0.09, I2 = 88%), survival at discharge (20% vs. 22%, RR 1.09, 95% CI 0.88–1.36, p = 0.42, I2 = 76%), or survival beyond 90 days (16% vs. 15%, RR 0.92, 95% CI 0.61–1.40, p = 0.69, I2 = 83%). The TSA showed firm evidence supporting the lack of benefit of IHT in terms of survival at discharge. However, the Z-curves failed to cross the conventional and TSA (futility) boundaries for FNO and survival beyond 90 days, indicating lack of sufficient evidence to draw firm conclusions regarding these outcomes.

Conclusion

In this meta-analysis of 9 studies, the utilization of IHT was not associated with a survival benefit at discharge. Although the meta-analysis showed lack of benefit of IHT in terms of FNO and survivals beyond 90 days, the corresponding TSA showed high probability of type-II statistical error, and therefore more randomized controlled trials powered for these outcomes are needed.
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Metadaten
Titel
Induced Hypothermia in Patients with Cardiac Arrest and a Non-shockable Rhythm: Meta-analysis and Trial Sequential Analysis
verfasst von
Mohammed Osman
Muhammad Bilal Munir
Sean Regner
Khansa Osman
Mina M. Benjamin
Babikir Kheiri
Pratik Agrawal
Paul McCarthy
Sudarshan Balla
Christopher M. Bianco
Publikationsdatum
30.06.2020
Verlag
Springer US
Erschienen in
Neurocritical Care / Ausgabe 1/2021
Print ISSN: 1541-6933
Elektronische ISSN: 1556-0961
DOI
https://doi.org/10.1007/s12028-020-01034-x

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