title: Therapeutic temperature management after cardiac arrest and the risk of bleeding: systematic review and meta-analysis.
abstract: OBJECTIVE
  Prognosis after cardiac arrest in the era of modern critical care is still poor with a high mortality of approximately 90%. Around 30% of the survivors have neurological impairments. Targeted temperature management (TTM) is the only treatment option which can improve mortality and neurological outcome. It is so far unclear if bleeding complications occur more often in patients undergoing TTM treatment.
  
  
  METHODS
  We conducted a systematic literature research in September 2013 including three major databases i.e. MEDLINE, EMBASE and CENTRAL. All studies were rated in respect to the ILCOR Guidelines and concerning their level of evidence and quality. We then performed a meta-analysis on bleeding disposition under TTM.
  
  
  RESULTS
  We initially found 941 studies out of which 34 matched our requirements and were thus included in our overview. Five studies including 599 patients were summarized in a meta-analysis concerning bleeding complications of all severities. There was a trend toward higher bleeding in patients treated with TTM (RR: 1.30, 95% CI: 0.97-1.74) which did not reach significance (p=0.085). Seven studies with an overall 599 patients were included in our meta-analysis on bleeding requiring transfusion. There was no significant difference in the incidence of severe bleeding with a risk ratio of 0.97 (95% CI: 0.61-1.56, p=0.909).
  
  
  CONCLUSIONS
  The data included in our meta-analysis indicate that, concerning the risk of bleeding, TTM is a safe method for patients after cardiac arrest. We did not observe a significantly higher risk for bleeding in patients undergoing TTM.
authors.affiliation: Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Department of Nephrology and Medical Intensive Care Medicine, Augustenburger Platz 1, 13353 Berlin, Germany. Electronic address: helena.stockmann@charite.de.
authors.forename: Helena
authors.initials: H
authors.lastname: Stockmann
authors.affiliation: Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Coordination Center for Clinical Trials, Department of Biostatistics, Augustenburger Platz 1, 13353 Berlin, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Krannich
authors.affiliation: Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Department of Nephrology and Medical Intensive Care Medicine, Augustenburger Platz 1, 13353 Berlin, Germany.
authors.forename: Tim
authors.initials: T
authors.lastname: Schroeder
authors.affiliation: Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Department of Nephrology and Medical Intensive Care Medicine, Augustenburger Platz 1, 13353 Berlin, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Storm
mesh_terms: D001833:Body Temperature Regulation / Q000502:physiology*; D016887:Cardiopulmonary Resuscitation / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006323:Heart Arrest / Q000401:mortality / Q000628:therapy*; D006470:Hemorrhage / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D007036:Hypothermia, Induced / Q000009:adverse effects* / Q000379:methods*; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods; D011379:Prognosis; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: Bleeding; Cardiac arrest; Hypothermia; Meta-analysis; Therapeutic temperature management