TTM2 (secondary analysis)
Trial question
Is hypothermia superior to normothermia in patients with cardiac arrest and shockable rhythm?
Study design
Multi-center
Single blinded
RCT
Population
Characteristics of study participants
14.0% female
86.0% male
N = 600
600 patients (87 female, 513 male).
Inclusion criteria: patients with cardiac arrest and shockable rhythm.
Key exclusion criteria: temperature < 30 °C on admission; coma before cardiac arrest; pregnancy; response to verbal commands after the return of spontaneous circulation; evidence of hypotension for > 30 minutes after the return of spontaneous circulation; terminal illness preceeding the arrest.
Interventions
N=294 hypothermia (targeted temperature of 33 °C).
N=306 normothermia (target temperature of < 37.8 °C).
Primary outcome
Survival at 6 months
70.4%
71.8%
71.8 %
53.8 %
35.9 %
17.9 %
0.0 %
Hypothermia
Normothermia
No significant
difference ↔
No significant difference in survival at 6 months (70.4% vs. 71.8%; RR 0.96, 96% CI 0.81 to 1.15).
Secondary outcomes
No significant difference in favorable functional outcome at 6 months (67.3% vs. 66%; RR 1.03, 95% CI 0.87 to 1.23).
Significant increase in occurrence of arrhythmias (21.2% vs. 14.1%; RR 1.49, 95% CI 1.05 to 2.14).
No significant difference in bleeding (6.1% vs. 3.3%; RR 1.86, 95% CI 0.89 to 4.14).
Safety outcomes
No significant differences in sepsis, bleeding, and pneumonia.
Significant difference in arrhythmias (21.2% vs. 14.1%).
Conclusion
In patients with cardiac arrest and shockable rhythm, hypothermia was not superior to normothermia with respect to survival at 6 months.
Reference
Fabio Silvio Taccone, Alain Cariou, Stefano Zorzi et al. Hypothermia versus normothermia in patients with cardiac arrest and shockable rhythm: a secondary analysis of the TTM-2 study. Crit Care. 2024 Oct 15;28(1):335.
Open reference URL