Effects of in-hospital low targeted temperature after out of hospital cardiac arrest: A systematic review with meta-analysis of randomized clinical trials.

Abstract

We performed this systematic review to evaluate the effectiveness of in-hospital low targeted temperature in adult patients after out of hospital cardiac arrest on survival and neurologic performance. We systematically searched MEDLINE and PUBMED from inception to April 2014. Citations were screened for studies evaluating the effect of in-hospital low targeted temperature in patients following out of hospital cardiac arrest. We analyzed randomized control trials (RCTs) that included adult patients resuscitated from out of hospital cardiac arrest, reporting mortality at hospital discharge and comparing in-hospital low targeted temperature with a control group. This meta-analysis included 6 RCTs and 1418 adult patients. In-hospital low targeted (low T) temperature was associated to a reduction in mortality at hospital discharge and at 6 months when compared with in-hospital targeted and not targeted temperature while there was no reduction in mortality comparing low and high targeted temperature. In patients with initial ventricular fibrillation/ventricular tachycardia rhythm of out of hospital cardiac arrest, low T was associated with a reduction in short and long-term mortality when compared with no targeted temperature while not when compared to high targeted temperature. Low T was associated with good neurologic performance at hospital discharge compared with in-hospital high or not targeted temperature. In-hospital low targeted temperature (<4 °C) improved short and long-term mortality when compared to no targeted temperature. In contrast, low T did not improve outcome compared with a slightly higher targeted temperature (≈ 36 °C).