Therapeutic Hypothermia is Associated With A Decrease in All-Cause Mortality in Cardiac Arrest Due To Shockable Rhythm.

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BACKGROUND: The benefits of therapeutic hypothermia (TH) in comatose patients post cardiac arrest remain uncertain. While some studies have shown benefit, others have shown equivocal results. We pooled data from randomized controlled trials to better study the outcomes of TH.

METHODS: Electronic research databases were queried up till September 21, 2021. Randomized controlled trials comparing TH (32°C to 34°C) with control (normothermia or temperature ≥ 36°C) in comatose post cardiac arrest patients were included.

RESULTS: The study included ten RCT's with 3988 subjects (1999 in the therapeutic hypothermia arm, and 1989 in the control arm). There was no difference in all-cause mortality between TH and control (OR 0.83; 95% confidence interval [CI]: 0.66 to 1.05; p = 0.08; I2 = 41%). There was no difference in the odds of poor neurological outcomes (OR 0.78; 95% CI: 0.61 to 1.01; p= 0.07; I2 = 43%). Subgroup analysis showed a decrease in all-cause mortality and poor neurological outcomes with therapeutic hypothermia in shockable rhythms (OR 0.55; 95% CI: 0.37 to 0.80; p = 1.00; I2 = 0% and OR 0.48; 95% CI 0.32 to 0.72; p = 0.92; I2 = 0% respectively).

CONCLUSION: Therapeutic hypothermia may be beneficial in reducing mortality and poor neurological outcomes in comatose post-cardiac arrest patients with shockable rhythms.

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Crit Pathw Cardiol