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Purpose <p>To compare the performance of targeted temperature management (TTM) at 33&#xa0;°C using intravascular (IC) vs. surface-cooling (SFC) devices after out-of-hospital cardiac arrest (OHCA).</p> Methods <p>A post hoc analysis including OHCA patients randomized to hypothermia in the TTM2-trial (NCT02908308) comparing hypothermia with normothermia. The main outcome was cooling performance, defined as the proportion of patients reaching target temperature &lt; 33.5&#xa0;°C within 4&#xa0;h, time outside temperature ranges during maintenance, rewarming rate and post-TTM fever. Exploratory outcomes included survival and good functional outcome, defined as modified Rankin Scale (mRS) scores of 0–3 at 6&#xa0;months, analyzed using Inverse Probability Treatment Weighting (IPTW).</p> Results <p>Among 930 patients randomized to hypothermia, 876 were treated with a cooling device and included in this study. Of those, 27.3% received IC devices, while 72.7% received SFC devices. The proportion reaching target temperature within 4&#xa0;h was higher with IC (IC: 69.6% vs. SFC: 49.2%; <i>p</i> &lt; 0.001). Temperature outside ranges during the cooling period and post-TTM fever were lower with IC compared to SFC (17.2% vs. 39.6%; <i>p</i> &lt; 0.001 and 0% vs. 6.3%; <i>p</i> &lt; 0.001, respectively). In the exploratory IPTW analysis, 6-month survival rates were 55.2% in the IC group and 50.2% in the SFC group (OR 1.22, 95% CI 0.89–1.68) and survival with good functional outcome at 6&#xa0;months was 51.1% patients in the IC group and 44.9% in the SFC (OR 1.28, 95% CI 0.93–1.77).</p> Conclusions <p>Among OHCA patients randomized to hypothermia in the TTM2 study, intravascular cooling, compared with surface cooling, was associated with better cooling performance.</p>

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Intravascular vs. surface cooling in out-of-hospital cardiac arrest patients receiving hypothermia after hospital arrival: a post hoc analysis of the TTM2 trial

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  • 发表日期：

    2025年4月28日

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  • Akil Awad,
  • Martin Jonsson,
  • Johan Holgersson,
  • Janus Christian Jakobsen,
  • Jacob Hollenberg,
  • Matthew Thomas,
  • Pedro D. Wendel Garcia,
  • Mattias Ringh,
  • Anders M. Grejs,
  • Thomas R. Keeble,
  • Jan Bělohlávek,
  • Alain Cariou,
  • Filippo Annoni,
  • Gisela Lilja,
  • Fabio Silvio Taccone,
  • Christian Rylander,
  • Niklas Nielsen,
  • Josef Dankiewicz,
  • Per Nordberg

摘要

Purpose

To compare the performance of targeted temperature management (TTM) at 33 °C using intravascular (IC) vs. surface-cooling (SFC) devices after out-of-hospital cardiac arrest (OHCA).

Methods

A post hoc analysis including OHCA patients randomized to hypothermia in the TTM2-trial (NCT02908308) comparing hypothermia with normothermia. The main outcome was cooling performance, defined as the proportion of patients reaching target temperature < 33.5 °C within 4 h, time outside temperature ranges during maintenance, rewarming rate and post-TTM fever. Exploratory outcomes included survival and good functional outcome, defined as modified Rankin Scale (mRS) scores of 0–3 at 6 months, analyzed using Inverse Probability Treatment Weighting (IPTW).

Results

Among 930 patients randomized to hypothermia, 876 were treated with a cooling device and included in this study. Of those, 27.3% received IC devices, while 72.7% received SFC devices. The proportion reaching target temperature within 4 h was higher with IC (IC: 69.6% vs. SFC: 49.2%; p < 0.001). Temperature outside ranges during the cooling period and post-TTM fever were lower with IC compared to SFC (17.2% vs. 39.6%; p < 0.001 and 0% vs. 6.3%; p < 0.001, respectively). In the exploratory IPTW analysis, 6-month survival rates were 55.2% in the IC group and 50.2% in the SFC group (OR 1.22, 95% CI 0.89–1.68) and survival with good functional outcome at 6 months was 51.1% patients in the IC group and 44.9% in the SFC (OR 1.28, 95% CI 0.93–1.77).

Conclusions

Among OHCA patients randomized to hypothermia in the TTM2 study, intravascular cooling, compared with surface cooling, was associated with better cooling performance.