Hypothermia versus normothermia in patients with cardiac arrest and shockable rhythm: a secondary analysis of the TTM-2 study

Fabio Silvio Taccone; Alain Cariou; Stefano Zorzi; Hans Friberg; Janus C. Jakobsen; Per Nordberg; Chiara Robba; Jan Belohlavek; Jan Hovdenes; Matthias Haenggi; Anders Åneman; Anders Grejs; Thomas R. Keeble; Filippo Annoni; Paul J. Young; Matt P. Wise; Tobias Cronberg; Gisela Lilja; Niklas Nielsen; Josef Dankiewicz

doi:10.1186/s13054-024-05119-3

Hypothermia versus normothermia in patients with cardiac arrest and shockable rhythm: a secondary analysis of the TTM-2 study

Fabio Silvio Taccone^*, Alain Cariou, Stefano Zorzi, Hans Friberg, Janus C. Jakobsen, Per Nordberg, Chiara Robba, Jan Belohlavek, Jan Hovdenes, Matthias Haenggi, Anders Åneman, Anders Grejs, Thomas R. Keeble, Filippo Annoni, Paul J. Young, Matt P. Wise, Tobias Cronberg, Gisela Lilja, Niklas Nielsen, Josef Dankiewicz

^*Corresponding author for this work

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Abstract

Background: The aim of this study was to assess whether hypothermia increased survival and improved functional outcome when compared with normothermia in out-of-hospital cardiac arrest (OHCA) patients with similar characteristics than in previous randomized studies showing benefits for hypothermia. Methods: Post hoc analysis of a pragmatic, multicenter, randomized clinical trial (TTM-2, NCT02908308). In this analysis, the subset of patients included in the trial who had similar characteristics to patients included in one previous randomized trial and randomized to hypothermia at 33 °C or normothermia (i.e. target < 37.8 °C) were considered. The primary outcome was survival at 6 months; secondary outcomes included favorable functional outcome at 6 months, defined as a modified Rankin scale of 0–3. Time-to-death and the occurrence of adverse events were also reported. Results: From a total of 1891 included in the TTM-2 study, 600 (31.7%) were included in the analysis, 294 in the hypothermia and 306 in the normothermia group. At 6 months, 207 of the 294 patients (70.4%) in the hypothermia group and 220 of the 306 patients (71.8%) in the normothermia group had survived (relative risk with hypothermia, 0.96; 95% confidence interval [CI], 0.81 to 1.15; P = 0.71). Also, 198 of the 294 (67.3%) in the hypothermia group and 202 of the 306 (66.0%) in the normothermia group had a favorable functional outcome (relative risk with hypothermia, 1.03; 95% CI, 0.87 to 1.23; P = 0.79). There was a significant increase in the occurrence of arrythmias in the hypothermia group (62/294, 21.2%) when compared to the normothermia group (43/306, 14.1%—OR 1.49, 95% CI 1.05–2.14; p = 0.026). Conclusions: In this study, hypothermia at 33˚C did not improve survival or functional outcome in a subset of patients with similar cardiac arrest characteristics to patients in whom benefit from hypothermia was shown in prior studies.

Original language	English
Article number	335
Pages (from-to)	1-9
Number of pages	9
Journal	Critical Care
Volume	28
Issue number	1
Early online date	15 Oct 2024
DOIs	https://doi.org/10.1186/s13054-024-05119-3
Publication status	Published - Dec 2024
Externally published	Yes

Bibliographical note

Copyright the Author(s) 2024. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

Keywords

Cardiac arrest
Hypothermia
Outcome
Shockable rhythm

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Taccone, F. S., Cariou, A., Zorzi, S., Friberg, H., Jakobsen, J. C., Nordberg, P., Robba, C., Belohlavek, J., Hovdenes, J., Haenggi, M., Åneman, A., Grejs, A., Keeble, T. R., Annoni, F., Young, P. J., Wise, M. P., Cronberg, T., Lilja, G., Nielsen, N., & Dankiewicz, J. (2024). Hypothermia versus normothermia in patients with cardiac arrest and shockable rhythm: a secondary analysis of the TTM-2 study. Critical Care, 28(1), 1-9. Article 335. https://doi.org/10.1186/s13054-024-05119-3

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title = "Hypothermia versus normothermia in patients with cardiac arrest and shockable rhythm: a secondary analysis of the TTM-2 study",

abstract = "Background: The aim of this study was to assess whether hypothermia increased survival and improved functional outcome when compared with normothermia in out-of-hospital cardiac arrest (OHCA) patients with similar characteristics than in previous randomized studies showing benefits for hypothermia. Methods: Post hoc analysis of a pragmatic, multicenter, randomized clinical trial (TTM-2, NCT02908308). In this analysis, the subset of patients included in the trial who had similar characteristics to patients included in one previous randomized trial and randomized to hypothermia at 33 °C or normothermia (i.e. target < 37.8 °C) were considered. The primary outcome was survival at 6 months; secondary outcomes included favorable functional outcome at 6 months, defined as a modified Rankin scale of 0–3. Time-to-death and the occurrence of adverse events were also reported. Results: From a total of 1891 included in the TTM-2 study, 600 (31.7%) were included in the analysis, 294 in the hypothermia and 306 in the normothermia group. At 6 months, 207 of the 294 patients (70.4%) in the hypothermia group and 220 of the 306 patients (71.8%) in the normothermia group had survived (relative risk with hypothermia, 0.96; 95% confidence interval [CI], 0.81 to 1.15; P = 0.71). Also, 198 of the 294 (67.3%) in the hypothermia group and 202 of the 306 (66.0%) in the normothermia group had a favorable functional outcome (relative risk with hypothermia, 1.03; 95% CI, 0.87 to 1.23; P = 0.79). There was a significant increase in the occurrence of arrythmias in the hypothermia group (62/294, 21.2%) when compared to the normothermia group (43/306, 14.1%—OR 1.49, 95% CI 1.05–2.14; p = 0.026). Conclusions: In this study, hypothermia at 33˚C did not improve survival or functional outcome in a subset of patients with similar cardiac arrest characteristics to patients in whom benefit from hypothermia was shown in prior studies.",

keywords = "Cardiac arrest, Hypothermia, Outcome, Shockable rhythm",

author = "Taccone, {Fabio Silvio} and Alain Cariou and Stefano Zorzi and Hans Friberg and Jakobsen, {Janus C.} and Per Nordberg and Chiara Robba and Jan Belohlavek and Jan Hovdenes and Matthias Haenggi and Anders {\AA}neman and Anders Grejs and Keeble, {Thomas R.} and Filippo Annoni and Young, {Paul J.} and Wise, {Matt P.} and Tobias Cronberg and Gisela Lilja and Niklas Nielsen and Josef Dankiewicz",

note = "Copyright the Author(s) 2024. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.",

year = "2024",

month = dec,

doi = "10.1186/s13054-024-05119-3",

language = "English",

volume = "28",

pages = "1--9",

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Taccone, FS, Cariou, A, Zorzi, S, Friberg, H, Jakobsen, JC, Nordberg, P, Robba, C, Belohlavek, J, Hovdenes, J, Haenggi, M, Åneman, A, Grejs, A, Keeble, TR, Annoni, F, Young, PJ, Wise, MP, Cronberg, T, Lilja, G, Nielsen, N & Dankiewicz, J 2024, 'Hypothermia versus normothermia in patients with cardiac arrest and shockable rhythm: a secondary analysis of the TTM-2 study', Critical Care, vol. 28, no. 1, 335, pp. 1-9. https://doi.org/10.1186/s13054-024-05119-3

TY - JOUR

T1 - Hypothermia versus normothermia in patients with cardiac arrest and shockable rhythm

T2 - a secondary analysis of the TTM-2 study

AU - Taccone, Fabio Silvio

AU - Cariou, Alain

AU - Zorzi, Stefano

AU - Friberg, Hans

AU - Jakobsen, Janus C.

AU - Nordberg, Per

AU - Robba, Chiara

AU - Belohlavek, Jan

AU - Hovdenes, Jan

AU - Haenggi, Matthias

AU - Åneman, Anders

AU - Grejs, Anders

AU - Keeble, Thomas R.

AU - Annoni, Filippo

AU - Young, Paul J.

AU - Wise, Matt P.

AU - Cronberg, Tobias

AU - Lilja, Gisela

AU - Nielsen, Niklas

AU - Dankiewicz, Josef

N1 - Copyright the Author(s) 2024. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

PY - 2024/12

Y1 - 2024/12

N2 - Background: The aim of this study was to assess whether hypothermia increased survival and improved functional outcome when compared with normothermia in out-of-hospital cardiac arrest (OHCA) patients with similar characteristics than in previous randomized studies showing benefits for hypothermia. Methods: Post hoc analysis of a pragmatic, multicenter, randomized clinical trial (TTM-2, NCT02908308). In this analysis, the subset of patients included in the trial who had similar characteristics to patients included in one previous randomized trial and randomized to hypothermia at 33 °C or normothermia (i.e. target < 37.8 °C) were considered. The primary outcome was survival at 6 months; secondary outcomes included favorable functional outcome at 6 months, defined as a modified Rankin scale of 0–3. Time-to-death and the occurrence of adverse events were also reported. Results: From a total of 1891 included in the TTM-2 study, 600 (31.7%) were included in the analysis, 294 in the hypothermia and 306 in the normothermia group. At 6 months, 207 of the 294 patients (70.4%) in the hypothermia group and 220 of the 306 patients (71.8%) in the normothermia group had survived (relative risk with hypothermia, 0.96; 95% confidence interval [CI], 0.81 to 1.15; P = 0.71). Also, 198 of the 294 (67.3%) in the hypothermia group and 202 of the 306 (66.0%) in the normothermia group had a favorable functional outcome (relative risk with hypothermia, 1.03; 95% CI, 0.87 to 1.23; P = 0.79). There was a significant increase in the occurrence of arrythmias in the hypothermia group (62/294, 21.2%) when compared to the normothermia group (43/306, 14.1%—OR 1.49, 95% CI 1.05–2.14; p = 0.026). Conclusions: In this study, hypothermia at 33˚C did not improve survival or functional outcome in a subset of patients with similar cardiac arrest characteristics to patients in whom benefit from hypothermia was shown in prior studies.

AB - Background: The aim of this study was to assess whether hypothermia increased survival and improved functional outcome when compared with normothermia in out-of-hospital cardiac arrest (OHCA) patients with similar characteristics than in previous randomized studies showing benefits for hypothermia. Methods: Post hoc analysis of a pragmatic, multicenter, randomized clinical trial (TTM-2, NCT02908308). In this analysis, the subset of patients included in the trial who had similar characteristics to patients included in one previous randomized trial and randomized to hypothermia at 33 °C or normothermia (i.e. target < 37.8 °C) were considered. The primary outcome was survival at 6 months; secondary outcomes included favorable functional outcome at 6 months, defined as a modified Rankin scale of 0–3. Time-to-death and the occurrence of adverse events were also reported. Results: From a total of 1891 included in the TTM-2 study, 600 (31.7%) were included in the analysis, 294 in the hypothermia and 306 in the normothermia group. At 6 months, 207 of the 294 patients (70.4%) in the hypothermia group and 220 of the 306 patients (71.8%) in the normothermia group had survived (relative risk with hypothermia, 0.96; 95% confidence interval [CI], 0.81 to 1.15; P = 0.71). Also, 198 of the 294 (67.3%) in the hypothermia group and 202 of the 306 (66.0%) in the normothermia group had a favorable functional outcome (relative risk with hypothermia, 1.03; 95% CI, 0.87 to 1.23; P = 0.79). There was a significant increase in the occurrence of arrythmias in the hypothermia group (62/294, 21.2%) when compared to the normothermia group (43/306, 14.1%—OR 1.49, 95% CI 1.05–2.14; p = 0.026). Conclusions: In this study, hypothermia at 33˚C did not improve survival or functional outcome in a subset of patients with similar cardiac arrest characteristics to patients in whom benefit from hypothermia was shown in prior studies.

KW - Cardiac arrest

KW - Hypothermia

KW - Outcome

KW - Shockable rhythm

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DO - 10.1186/s13054-024-05119-3

M3 - Article

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AN - SCOPUS:85206470958

SN - 1364-8535

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JF - Critical Care

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ER -

Hypothermia versus normothermia in patients with cardiac arrest and shockable rhythm: a secondary analysis of the TTM-2 study

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