Background
Methods
Data search
Study selection
Data extraction
Risk-of-bias assessment
Study outcome definition
Data synthesis and analysis
Results
Search results and study selection
Characteristics of studies
First author, publication year (site) [reference] | Timing of intervention | Primary cardiac rhythm | Cooling method (intervention) | Cooling methods in-hospital (intervention/control) | Outcome (efficacy and safety) | Outcome (pre-hospital safety) | ||
---|---|---|---|---|---|---|---|---|
Bernard, 2002 (Australia) [6] | Post-arrest | VF | Application of ice packs to patient’s head and torso | Application of ice packs to patient’s head, neck, torso and limbs. When 33 °C temperature was achieved, ice packs were removed | No cooling implemented pre-hospital or in-hospital | Discharged directly to home or to a rehabilitation facility | Survival/favourable outcome at dischargea | N/A |
Bernard, 2010 (Australia) [17] | Post-arrest | VF | Infusion of up to 2 L of ice-cold lactated Ringer’s solution commenced at 100 ml/minute | Additional 10–20 ml/kg rapid infusion of ice-cold Ringer’s lactate, then surface cooling pads | Rapid infusion of 40 ml/kg of ice-cold Ringer’s lactate, then surface cooling pads | Discharged directly to home or to a rehabilitation facility | Survival/favourable outcome at discharge, temperature at admissiona | Pulmonary oedema |
Bernard, 2012 (Australia) [18] | Post-arrest | Asystole/PEA | Cooled intravenous fluids, ice packs and cooling blankets | Additional 40 ml/kg rapid infusion of ice-cold Hartmann’s solution, then surface cooling pads | 40 ml/kg rapid infusion of ice-cold Hartmann’s solution, then surface cooling pads | Discharged directly to home or to a rehabilitation facility | Survival/favourable outcome at discharge, temperature at admission, pre-hospital survivala | Pulmonary oedema |
Bernard, 2016 (Australia) [11] | Intra-arrest | VF, VT, Asystole, PEA | Infusion of 30 ml/kg cold saline (maximum 2 L) | N/A | N/A | Discharged directly to home or to a rehabilitation facility | Survival at hospital discharge, discharge to home from hospital, proportion of patients in shockable and non-shockable rhythms with ROSCa | Pulmonary oedema |
Castren, 2010 (multi-site) [23] | Intra-arrest | VF, VT, Asystole, PEA | Trans-nasal evaporative cooling | Cooled in hospital according to institutional standards | Cooled in-hospital according to institutional standards | CPC score 1 or 2 | Safety and efficacy of RhinoChill intra-nasal cooling system (BeneChill, San Diego, CA, USA), temperature at admission, ROSC, survival at discharge, neurological functiona | Pulmonary oedema, re-arrest, bleeding |
Debaty, 2014 (France) [22] | Intra-arrest | VF, VT, PEA, Asystole | Up to 2000 ml of ice-cold 0.9% saline solution at 100 ml/minute, then surface cooling using gel pads | Cooling continued with cold saline infusion, cooling mattress, cold air circulation and/or extracorporeal life support | Cooled with cold saline infusion, cooling mattress, cold air circulation and/or extracorporeal life support | CPC score 1 or 2 | Temperature at admission, ROSC, survival and neurological function (discharge/30 days/1 year) | Pulmonary oedema, bleeding, infection, arrhythmia |
Kamarainen, 2009 (Finland) [21] | Post-arrest | VF, VT, PEA, Asystole | 4 °C Ringer’s acetate at approximately 100 ml/minute | Cooling continued at the discretion of hospital physicians | Cooling initiated at the discretion of hospital physicians | CPC score 1 or 2 | Temperature at admission, survival at discharge, neurological functiona | Pulmonary oedema, re-arrest |
Kim, 2007 (United States) [20] | Post-arrest | VF, VT, PEA, Asystole | Up to 2 L of 4 °C normal saline solution | According to physician preferences | According to physician preferences | Absence of severe neurological deficit (undefined) | Temperature at admission, survival at dischargea | Pulmonary oedema, re-arrest |
Kim, 2014 (United States) [19] | Post-arrest | VF, VT, PEA, Asystole | Up to 2 L of 4 °C normal saline solution | Surface and intravascular cooling | Surface and intravascular cooling | Full neurological recovery/mild impairment | Survival at discharge,a neurological functiona and temperature at admission | Pulmonary oedema, re-arrest |
Scales, 2017 (Canada) [12] | Post-arrest | VF, VT, PEA, Asystole | Application of ice packs to neck, axillae and groins, and infusion of up to 2 L of cold saline (0.9% sodium chloride solution at approximately 4 °C) | According to physician preferences | According to physician preferences | mRS 0, 1 or 2 | Successful TTM,a survival to hospital discharge, good neurological outcome, temperature at admission | Pulmonary oedema, re-arrest |
First author, year (site) [reference] | Number of participants (total/I/C) | Survival to discharge (I vs C) | Survival of those with shockable rhythm (I vs C) | Temperature at hospital arrival (I vs C) | Pulmonary oedema (I vs C) | Re-arrest (I vs C) | Mean pre-hospital volume infused (ml) | Favourable neurological outcome (I vs C) | Survival at hospital arrival (I vs C) | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Bernard, 2002 (Australia) [6] | 77/43/34 | 21 (49%) | 11 (32%) | N/A | N/A | 35.0 | 35.5 | N/A | N/A | N/A | N/A | N/A | 21 (49%) | 9 (26%) | N/A | N/A |
Bernard, 2010 (Australia) [17] | 234/118/116 | 56 (47%) | 62 (53%) | N/A | N/A | 34.6 | 35.4 | 0 | 0 | 0 | 0 | 1900 | 56 (48%) | 61 (53%) | N/A | N/A |
Bernard, 2012 (Australia) [18] | 163/82/81 | 11 (13%) | 7 (9%) | N/A | N/A | 34.4 | 35.7 | 0 | 0 | N/A | N/A | 1500 | 10 (12%) | 7 (10%) | 75 (91%) | 74 (91%) |
Bernard, 2016 (Australia) [11] | 1198/618/580 | 63 (10%) | 66 (11%) | 55 (19%) | 62 (23%) | 34.7 | 35.4 | 62 (10%) | 26 (45%) | N/A | N/A | 1200 | 63 (10%) | 63 (11%) | 304 (49%) | 317 (55%) |
Castren, 2010 (multi-site) [23] | 200/96/104 | 14 (15%) | 13 (13%) | 10 (37%) | 10 (33%) | 34.2 | 35.5 | 0 | 0 | 3 (3%) | 2 (2%) | N/A | 11 (11%) | 9 (9%) | 32 (33%) | 42 (41%) |
Debaty, 2014 (France) [22] | 245/123/122 | 7 (6%) | 5 (4%) | N/A | N/A | 33.9 | 35 | 7 (6%) | 8 (7%) | N/A | N/A | 1000 | 7 (6%) | 4 (3%) | 41 (33%) | 36 (30%) |
Kamarainen, 2009 (Finland) [21] | 37/19/18 | 11 (58%) | 10 (56%) | N/A | N/A | 34.1 | 35.2 | 0 | 0 | 2 (11%) | 3 (17%) | 2370 | 8 (42%) | 8 (44%) | N/A | N/A |
Kim, 2007 (United States) [20] | 125/63/62 | 21 (67%) | 18 (71%) | 19 (66%) | 10 (45%) | 34.7 | 35.7 | 24 (38%) | 27 (44%) | 15 (24%) | 13 (21%) | 1236 | 19 (30%) | 16 (26%) | 49 (78%) | 48 (77%) |
Kim, 2014 (United States) [19] | 1359/688/671 | 259 (38%) | 249 (37%) | 183 (63%) | 187 (64%) | 34.8 | 35.8 | 256 (37%) | 184 (27%) | 176 (26%) | 138 (21%) | 1435 | 231 (34%) | 225 (33%) | 679 (99%) | 660 (98%) |
Scales, 2017 (Canada) [12] | 582/279/303 | 92 (33%) | 98 (31%) | 79 (64%) | 74 (55%) | 35.1 | 35.2 | 33 (12%) | 54 (18%) | 21 (8%) | 25 (8%) | 640 | 82 (29%) | 76 (26%) | 250 (90%) | 258 (85%) |