• Lorenzo Calabró, Wulfran Bougouin, Alain Cariou, Chiara De Fazio, Markus Skrifvars, Eldar Soreide, Jacques Creteur, Hans Kirkegaard, Stéphane Legriel, Lascarrou Jean-Baptiste JB Medical Intensive Care Unit, University Hospital Center, PARCC Inserm UMR 970, Nantes, France., Bruno Megarbane, Nicolas Deye, and Fabio Silvio Taccone.
• Department of Intensive Care, Cliniques Universitaires de Bruxelles Hopital Erasme, Erasmus Hospital, Université Libre de Bruxelles (ULB), Route de Lennik, 808, 1070, Brussels, Belgium.
• Crit Care. 2019 Aug 23; 23 (1): 285.

BackgroundAlthough targeted temperature management (TTM) is recommended in comatose survivors after cardiac arrest (CA), the optimal method to deliver TTM remains unknown. We performed a meta-analysis to evaluate the effects of different TTM methods on survival and neurological outcome after adult CA.MethodsWe searched on the MEDLINE/PubMed database until 22 February 2019 for comparative studies that evaluated at least two different TTM methods in CA patients. Data were extracted independently by two authors. We used the Newcastle-Ottawa Scale and a modified Cochrane ROB tools for assessing the risk of bias of each study. The primary outcome was the occurrence of unfavorable neurological outcome (UO); secondary outcomes included overall mortality.ResultsOur search identified 6886 studies; 22 studies (n = 8027 patients) were included in the final analysis. When compared to surface cooling, core methods showed a lower probability of UO (OR 0.85 [95% CIs 0.75-0.96]; p = 0.008) but not mortality (OR 0.88 [95% CIs 0.62-1.25]; p = 0.21). No significant heterogeneity was observed among studies. However, these effects were observed in the analyses of non-RCTs. A significant lower probability of both UO and mortality were observed when invasive TTM methods were compared to non-invasive TTM methods and when temperature feedback devices (TFD) were compared to non-TFD methods. These results were significant particularly in non-RCTs.ConclusionsAlthough existing literature is mostly based on retrospective or prospective studies, specific TTM methods (i.e., core, invasive, and with TFD) were associated with a lower probability of poor neurological outcome when compared to other methods in adult CA survivors (CRD42019111021).

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