Efficacy of intravascular cooling <i>versus</i> surface cooling on the prognosis of patients with cardiac arrest: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

LU Zongqing ^1,2 , ZHU Xingxing ^1,2 , JIA Di ^1,2 , HUA Tianfeng ^1,2 , XIAO Wenyan ^1,2 , ZHANG Jin ^1,2 ,  YANG Min ^1,2

1. The Second Department of Intensive Care Unit, The Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, P.R.China;
2. The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, P.R.China;

Corresponding author：

YANG Min, Email: 512130761@qq.com

Keywords：

Cardiac arrest; Mild hypothermia; Target temperature management; Systematic review; Meta-analysis; Cohort study; Randomized controlled trial

DOI：

10.7507/1672-2531.201908060

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Objective To systematically review the efficacy and safety of intravascular cooling versus surface cooling for induced mild hypothermia on the prognosis of patients with cardiac arrest (CA) after resuscitation.Methods PubMed, EMbase, The Cochrane Library, CNKI and WanFang Data databases were electronically searched to collect cohort studies and randomized controlled trials (RCTs) about the efficacy and safety of intravascular cooling versus surface cooling for CA patients after resuscitation from inception to July 2019. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using Stata 13.0 software.Results A total of 9 cohort studies and 3 RCTs involving 2 104 patients were included. The results of meta-analysis showed that: the rate of good neurological function was significantly higher (OR=1.45, 95%CI 1.18 to 1.78, P<0.001) and the induction time was significantly shorter (SMD=−1.35, 95%CI −2.34 to −0.36, P=0.008) in the intravascular cooling group, but there was no statistical difference in mortality between two groups (OR=0.84, 95%CI 0.70 to 1.00, P=0.053). In terms of complications related to mild hypothermia, the rate of excessive hypothermia (OR=0.27, 95%CI 0.18 to 0.41, P<0.001) and arrhythmia (OR=0.60, 95%CI 0.40 to 0.89, P=0.012) was significantly lower in the patients treated with intravascular cooling, but the incidence of coagulopathy was higher (OR=1.61, 95%CI 1.05 to 2.49, P=0.03). There was no statistical difference in the incidence of pneumonia between two groups (OR=1.20, 95%CI 0.94 to 1.53, P=0.147).Conclusion Current evidence shows that intravascular cooling has significant neurological protection for patients with CA compared with surface cooling since it can decrease the induction time and the rate of excessive hypothermia and arrhythmia, but it may have a negative effect on the coagulation function. Due to the limited quality and quantity of the included studies, more high-quality studies are needed to verify the above conclusion.

Citation： LU Zongqing, ZHU Xingxing, JIA Di, HUA Tianfeng, XIAO Wenyan, ZHANG Jin, YANG Min. Efficacy of intravascular cooling versus surface cooling on the prognosis of patients with cardiac arrest: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2020, 20(2): 160-167. doi: 10.7507/1672-2531.201908060 Copy

1.	王立祥, 孟庆义, 余涛. 2016 中国心肺复苏专家共识. 中华危重病急救医学, 2016, 28(12): 1059-1079.
2.	Rossetti AO, Rabinstein AA, Oddo M. Neurological prognostication of outcome in patients in coma after cardiac arrest. Lancet Neurol, 2016, 15(6): 597-609.
3.	Michael HE, Cerchiari PM. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med, 2002, 346(8): 549-556.
4.	Kim F, Nichol G, Maynard C, et al. Effect of prehospital induction of mild hypothermia on survival and neurological status among adults with cardiac arrest: a randomized clinical trial. JAMA, 2014, 311(1): 45-52.
5.	Callaway CW, Donnino MW, Fink EL, et al. Part 8: post-cardiac arrest care: 2015 American heart association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation, 2015, 132(18 Suppl 2): S465-482.
6.	Geocadin RG, Wijdicks E, Armstrong MJ, et al. Practice guideline summary: Reducing brain injury following cardiopulmonary resuscitation. Neurology, 2017, 88(22): 2141-2149.
7.	Vaity C, Al-Subaie N, Cecconi M. Cooling techniques for targeted temperature management post-cardiac arrest. Crit Care, 2015, 19: 103.
8.	Lyden PD, Allgren RL, Ng K, et al. Intravascular cooling in the treatment of stroke (ICTuS): early clinical experience. J Stroke Cerebrovasc Dis, 2005, 14(3): 107-114.
9.	Gillies MA, Pratt R, Whiteley C, et al. Therapeutic hypothermia after cardiac arrest: a retrospective comparison of surface and endovascular cooling techniques. Resuscitation, 2010, 81(9): 1117-1122.
10.	Oh SH, Oh JS, Kim YM, et al. An observational study of surface versus endovascular cooling techniques in cardiac arrest patients: a propensity-matched analysis. Crit Care, 2015, 19: 85.
11.	Stanger D, Mihajlovic V, Singer J, et al. Editor’s choice-effects of targeted temperature management on mortality and neurological outcome: a systematic review and meta-analysis. Eur Heart J Acute Cardiovasc Care, 2018, 7(5): 467-477.
12.	Calabró L, Bougouin W, Cariou A, et al. Effect of different methods of cooling for targeted temperature management on outcome after cardiac arrest: a systematic review and meta-analysis. Crit Care, 2019, 23(1): 285.
13.	曾宪涛, 刘慧, 陈曦, 等. Meta 分析系列之四: 观察性研究的质量评价工具. 中国循证心血管医学杂志, 2012, 4(4): 297-299.
14.	Flemming K, Simonis G, Ziegs E, et al. Comparison of external and intravascular cooling to induce hypothermia in patients after CPR. Ger Med Sci, 2006, 4: 1-4.
15.	Andrade FI, Schutte M, Oosterloo E, et al. Therapeutic mild hypothermia improves outcome after out-of-hospital cardiac arrest. Neth Heart J, 2009, 17(10): 378-384.
16.	de Waard MC, Banwarie RP, Jewbali LS, et al. Intravascular versus surface cooling speed and stability after cardiopulmonary resuscitation. Emerg Med J, 2015, 32(10): 775-780.
17.	Finley Caulfield A, Rachabattula S, Eyngorn I, et al. A comparison of cooling techniques to treat cardiac arrest patients with hypothermia. Stroke Res Treat, 2011, 2011: 690506.
18.	Forkmann M, Kolschmann S, Holzhauser L, et al. Target temperature management of 33 degrees C exerts beneficial haemodynamic effects after out-of-hospital cardiac arrest. Acta Cardiol, 2015, 70(4): 451-459.
19.	Sonder P, Janssens GN, Beishuizen A, et al. Efficacy of different cooling technologies for therapeutic temperature management: A prospective intervention study. Resuscitation, 2018, 124: 14-20.
20.	Tømte Ø, Drægni T, Mangschau A, et al. A comparison of intravascular and surface cooling techniques in comatose cardiac arrest survivors. Crit Care Med, 2011, 39(3): 443-449.
21.	Deye N, Cariou A, Girardie P, et al. Endovascular versus external targeted temperature management for patients with out-of-hospital cardiac arrest: a randomized, controlled study. Circulation, 2015, 132(3): 182-193.
22.	Look X, Li H, Ng M, et al. Randomized controlled trial of internal and external targeted temperature management methods in post- cardiac arrest patients. Am J Emerg Med, 2018, 36(1): 66-72.
23.	Pittl U, Schratter A, Desch S, et al. Invasive versus non-invasive cooling after in- and out-of-hospital cardiac arrest: a randomized trial. Clin Res Cardiol, 2013, 102(8): 607-614.
24.	Wan X, Wang W, Liu J, et al. Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol, 2014, 14: 135.
25.	郑康, 马青变. 血管内降温治疗临床应用进展. 临床急诊杂志, 2014, 15(8): 511-514.
26.	Jang JS, Choi KN, Jin HY, et al. Meta-analysis of three randomized trials and nine observational studies comparing drug-eluting stents versus coronary artery bypass grafting for unprotected left main coronary artery disease. Am J Cardiol, 2012, 110(10): 1411-1418.
27.	Polderman KH. Mechanisms of action, physiological effects, and complications of hypothermia. Crit Care Med, 2009, 37(7 Suppl): S186-S202.
28.	罗德惠, 童铁军, 万翔, 等. 样本量、中位数、极值或四分位数到均数与标准差的转换. 中国循证医学杂志, 2017, 17(11): 1350-1356.
29.	Zhang Z, Xu X, Ni H. Small studies may overestimate the effect sizes in critical care meta-analyses: a meta-epidemiological study. Crit Care, 2013, 17(1): R2.

1. 王立祥, 孟庆义, 余涛. 2016 中国心肺复苏专家共识. 中华危重病急救医学, 2016, 28(12): 1059-1079.
2. Rossetti AO, Rabinstein AA, Oddo M. Neurological prognostication of outcome in patients in coma after cardiac arrest. Lancet Neurol, 2016, 15(6): 597-609.
3. Michael HE, Cerchiari PM. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med, 2002, 346(8): 549-556.
4. Kim F, Nichol G, Maynard C, et al. Effect of prehospital induction of mild hypothermia on survival and neurological status among adults with cardiac arrest: a randomized clinical trial. JAMA, 2014, 311(1): 45-52.
5. Callaway CW, Donnino MW, Fink EL, et al. Part 8: post-cardiac arrest care: 2015 American heart association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation, 2015, 132(18 Suppl 2): S465-482.
6. Geocadin RG, Wijdicks E, Armstrong MJ, et al. Practice guideline summary: Reducing brain injury following cardiopulmonary resuscitation. Neurology, 2017, 88(22): 2141-2149.
7. Vaity C, Al-Subaie N, Cecconi M. Cooling techniques for targeted temperature management post-cardiac arrest. Crit Care, 2015, 19: 103.
8. Lyden PD, Allgren RL, Ng K, et al. Intravascular cooling in the treatment of stroke (ICTuS): early clinical experience. J Stroke Cerebrovasc Dis, 2005, 14(3): 107-114.
9. Gillies MA, Pratt R, Whiteley C, et al. Therapeutic hypothermia after cardiac arrest: a retrospective comparison of surface and endovascular cooling techniques. Resuscitation, 2010, 81(9): 1117-1122.
10. Oh SH, Oh JS, Kim YM, et al. An observational study of surface versus endovascular cooling techniques in cardiac arrest patients: a propensity-matched analysis. Crit Care, 2015, 19: 85.
11. Stanger D, Mihajlovic V, Singer J, et al. Editor’s choice-effects of targeted temperature management on mortality and neurological outcome: a systematic review and meta-analysis. Eur Heart J Acute Cardiovasc Care, 2018, 7(5): 467-477.
12. Calabró L, Bougouin W, Cariou A, et al. Effect of different methods of cooling for targeted temperature management on outcome after cardiac arrest: a systematic review and meta-analysis. Crit Care, 2019, 23(1): 285.
13. 曾宪涛, 刘慧, 陈曦, 等. Meta 分析系列之四: 观察性研究的质量评价工具. 中国循证心血管医学杂志, 2012, 4(4): 297-299.
14. Flemming K, Simonis G, Ziegs E, et al. Comparison of external and intravascular cooling to induce hypothermia in patients after CPR. Ger Med Sci, 2006, 4: 1-4.
15. Andrade FI, Schutte M, Oosterloo E, et al. Therapeutic mild hypothermia improves outcome after out-of-hospital cardiac arrest. Neth Heart J, 2009, 17(10): 378-384.
16. de Waard MC, Banwarie RP, Jewbali LS, et al. Intravascular versus surface cooling speed and stability after cardiopulmonary resuscitation. Emerg Med J, 2015, 32(10): 775-780.
17. Finley Caulfield A, Rachabattula S, Eyngorn I, et al. A comparison of cooling techniques to treat cardiac arrest patients with hypothermia. Stroke Res Treat, 2011, 2011: 690506.
18. Forkmann M, Kolschmann S, Holzhauser L, et al. Target temperature management of 33 degrees C exerts beneficial haemodynamic effects after out-of-hospital cardiac arrest. Acta Cardiol, 2015, 70(4): 451-459.
19. Sonder P, Janssens GN, Beishuizen A, et al. Efficacy of different cooling technologies for therapeutic temperature management: A prospective intervention study. Resuscitation, 2018, 124: 14-20.
20. Tømte Ø, Drægni T, Mangschau A, et al. A comparison of intravascular and surface cooling techniques in comatose cardiac arrest survivors. Crit Care Med, 2011, 39(3): 443-449.
21. Deye N, Cariou A, Girardie P, et al. Endovascular versus external targeted temperature management for patients with out-of-hospital cardiac arrest: a randomized, controlled study. Circulation, 2015, 132(3): 182-193.
22. Look X, Li H, Ng M, et al. Randomized controlled trial of internal and external targeted temperature management methods in post- cardiac arrest patients. Am J Emerg Med, 2018, 36(1): 66-72.
23. Pittl U, Schratter A, Desch S, et al. Invasive versus non-invasive cooling after in- and out-of-hospital cardiac arrest: a randomized trial. Clin Res Cardiol, 2013, 102(8): 607-614.
24. Wan X, Wang W, Liu J, et al. Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol, 2014, 14: 135.
25. 郑康, 马青变. 血管内降温治疗临床应用进展. 临床急诊杂志, 2014, 15(8): 511-514.
26. Jang JS, Choi KN, Jin HY, et al. Meta-analysis of three randomized trials and nine observational studies comparing drug-eluting stents versus coronary artery bypass grafting for unprotected left main coronary artery disease. Am J Cardiol, 2012, 110(10): 1411-1418.
27. Polderman KH. Mechanisms of action, physiological effects, and complications of hypothermia. Crit Care Med, 2009, 37(7 Suppl): S186-S202.
28. 罗德惠, 童铁军, 万翔, 等. 样本量、中位数、极值或四分位数到均数与标准差的转换. 中国循证医学杂志, 2017, 17(11): 1350-1356.
29. Zhang Z, Xu X, Ni H. Small studies may overestimate the effect sizes in critical care meta-analyses: a meta-epidemiological study. Crit Care, 2013, 17(1): R2.

Chinese Journal of Evidence-Based Medicine

Efficacy of intravascular cooling versus surface cooling on the prognosis of patients with cardiac arrest: a meta-analysis

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