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Journal Club 20 November 2013


Targeted Temperature Management at 33°C versus 36°C after Cardiac Arrest





Unconscious survivors of out-of-hospital cardiac arrest have a high risk of death or
poor neurologic function. Therapeutic hypothermia is recommended by international
guidelines, but the supporting evidence is limited, and the target temperature
associated with the best outcome is unknown. Our objective was to compare
two target temperatures, both intended to prevent fever.


In an international trial, we randomly assigned 950 unconscious adults after out-ofhospital
cardiac arrest of presumed cardiac cause to targeted temperature management
at either 33°C or 36°C. The primary outcome was all-cause mortality through
the end of the trial. Secondary outcomes included a composite of poor neurologic
function or death at 180 days, as evaluated with the Cerebral Performance Category
(CPC) scale and the modified Rankin scale.


In total, 939 patients were included in the primary analysis. At the end of the trial,
50% of the patients in the 33°C group (235 of 473 patients) had died, as compared
with 48% of the patients in the 36°C group (225 of 466 patients) (hazard ratio with
a temperature of 33°C, 1.06; 95% confidence interval [CI], 0.89 to 1.28; P = 0.51). At
the 180-day follow-up, 54% of the patients in the 33°C group had died or had poor
neurologic function according to the CPC, as compared with 52% of patients in the
36°C group (risk ratio, 1.02; 95% CI, 0.88 to 1.16; P = 0.78). In the analysis using the
modified Rankin scale, the comparable rate was 52% in both groups (risk ratio,
1.01; 95% CI, 0.89 to 1.14; P = 0.87). The results of analyses adjusted for known
prognostic factors were similar.


In unconscious survivors of out-of-hospital cardiac arrest of presumed cardiac
cause, hypothermia at a targeted temperature of 33°C did not confer a benefit as
compared with a targeted temperature of 36°C.

Other related material

2002 Randomized clinical trial
Editorial of presented paper
Pre-hospital cooling for cardiac arrest
Editorial: pre-hospital cooling for cardiac arrest

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