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Therapeutic Hypothermia Following Cardiopulmonary Arrest: A Systematic Review and Meta-Analysis with Trial Sequential Analysis

Robert Maclaren

Robert Maclaren

Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical SciencesAurora, USA
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Maclaren, Robert
, 
Sterling Torian

Sterling Torian

Department of Pharmacy, TriStar Centennial Medical CenterNashville, USA
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Torian, Sterling
, 
Tyree Kiser

Tyree Kiser

Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical SciencesAurora, USA
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Kiser, Tyree
, 
Scott Mueller

Scott Mueller

Department of Pharmacy, University of Colorado HospitalAurora, USA
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Mueller, Scott
 and 
Paul Reynolds

Paul Reynolds

Department of Pharmacy, VA Eastern Colorado Health Care SystemAurora, USA
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Reynolds, Paul
  
May 08, 2023
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Article Category: Review
Published Online: May 08, 2023
Page range: 64 - 72
Received: Dec 28, 2022
Accepted: Apr 26, 2023
DOI: https://doi.org/10.2478/jccm-2023-0015
Keywords
© 2023 Robert Maclaren et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.

Fig. 1.

Forest Plot for Favorable Neurologic Outcome. Abbreviations: M-H, Mantel-Haenszel random effects; CI, confidence interval.
Forest Plot for Favorable Neurologic Outcome. Abbreviations: M-H, Mantel-Haenszel random effects; CI, confidence interval.

Fig. 2.

Forest plot for All Cause Mortality at Longest Follow-Up Interval. Abbreviations: M-H, Mantel-Haenszel random effects; CI, confidence interval.
Forest plot for All Cause Mortality at Longest Follow-Up Interval. Abbreviations: M-H, Mantel-Haenszel random effects; CI, confidence interval.

Fig. 3.

Adverse Events. Abbreviations: M-H, Mantel-Haenszel random effects; CI, confidence interval.
Adverse Events. Abbreviations: M-H, Mantel-Haenszel random effects; CI, confidence interval.

Characteristics of Included Studies

Study Mild Hypothermia Standard of Care Initial Shockable Rhythm Out-of-Hospital Arrest Median Time to ROSC Bystander CPR Duration of Cooling Surface Cooling
Bernard. HACA. 2002. 32 to 34 Normothermia 96% 87% 22 46% 24 100%
Bernard. OHCA. 2002. 33 Normothermia 100% 100% 26 58% 18 100%
Nielsen. TTM. 2013. 33 36 80% 100% 25 73% 28 76%
Lascarrou. HY PERION. 2019. 33 37 0% 73% NR 70% 24 85%
Dankiewicz. TTM2. 2021. 33 37.5 74% 100% 25 80% 28 70%

Absolute Percentages of Adverse Effects at the Participant Levela

Adverse Effect Hypothermia Normothermia Absolute Difference Fragility Indexb
Arrhythmias 306/1389(22%) 227/1390 (16.3%) 5.7% 38
Bleeding 95/1389 (6.8%) 89/1391 (6.4%) 0.4% 0
Seizures 77/463 (16.6%) 83/464 (17.9%) −1.3% 0
Infection 593/1388 (42.7%) 544/1391 (39.1%) 3.6% 0
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