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

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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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Authors and Affiliations

  1. Division of Cardiology, West Virginia University School of Medicine, Morgantown, WV, USA

    Mohammed Osman, Muhammad Bilal Munir, Sean Regner, Mina M. Benjamin, Pratik Agrawal, Sudarshan Balla & Christopher M. Bianco

  2. Division of Cardiology, University of California San Diego, La Jolla, CA, USA

    Muhammad Bilal Munir

  3. Michigan Health Specialist, Michigan State University, Flint, MI, USA

    Khansa Osman

  4. Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR, USA

    Babikir Kheiri

  5. Division of Critical Care Medicine, West Virginia University School of Medicine, Morgantown, WV, USA

    Paul McCarthy

  6. WVU Heart and Vascular Institute, West Virginia University, One Medical Center Drive Box 8003, Morgantown, WV, 26506, USA

    Mohammed Osman

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  1. Mohammed Osman
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  2. Muhammad Bilal Munir
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  3. Sean Regner
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  4. Khansa Osman
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  9. Sudarshan Balla
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  10. Christopher M. Bianco
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Contributions

Conception and design, analysis and interpretation of the data was done by MO and CB. Drafting of the article was done by MBM and SR. Provision of study materials or patients was done by MO, SR, BK and PA. Statistical expertise was done by MO and BK. Administrative, technical, or logistic support was done by CB, SB and PM. Collection and assembly of data was done by SR, PA and MBM. Critical revision of the article for important intellectual content and final approval of the article was done by all authors.

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Correspondence to Mohammed Osman.

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Osman, M., Munir, M.B., Regner, S. et al. Induced Hypothermia in Patients with Cardiac Arrest and a Non-shockable Rhythm: Meta-analysis and Trial Sequential Analysis. Neurocrit Care 34, 279–286 (2021). https://doi.org/10.1007/s12028-020-01034-x

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  • DOI: https://doi.org/10.1007/s12028-020-01034-x

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