TTM
Trial question
What is the role of targeted temperature at 33 degree C in unconscious adults after out-of-hospital cardiac arrest?
Study design
Multi-center
Single blinded
RCT
Population
Characteristics of study participants
19.0% female
81.0% male
N = 939
939 patients (178 female, 761 male).
Inclusion criteria: unconscious adult patients after out-of-hospital cardiac arrest of presumed cardiac cause.
Key exclusion criteria: interval from the return of spontaneous circulation to screening > 240 minutes, unwitnessed arrest with asystole as the initial rhythm, acute ICH or stroke, and a body temperature < 30 degree C.
Interventions
N=473 cooling to 33 degree C (target body temperature of 33 °C).
N=466 cooling to 36 degree C (target body temperature of 36 °C).
Primary outcome
All-cause death
50%
48%
50.0 %
37.5 %
25.0 %
12.5 %
0.0 %
Cooling to 33 degree
C
Cooling to 36 degree
C
No significant
difference ↔
No significant difference in all-cause death (50% vs. 48%; HR 1.06, 95% CI 0.89 to 1.28).
Secondary outcomes
No significant difference in poor neurologic function (CPC scale) or death at 6 months (54% vs. 52%; HR 1.02, 95% CI 0.88 to 1.16).
No significant difference in poor neurologic function by mRS or death at 6 months (52% vs. 52%; HR 1.01, 95% CI 0.89 to 1.14).
Conclusion
In unconscious adult patients after out-of-hospital cardiac arrest of presumed cardiac cause, cooling to 33 degree C was not superior to cooling to 36 degree C with respect to a all-cause death.
Reference
Nielsen N, Wetterslev J, Cronberg T et al. Targeted temperature management at 33°C versus 36°C after cardiac arrest. N Engl J Med. 2013 Dec 5;369(23):2197-206.
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