title: Intravascular versus surface cooling for targeted temperature management after out-of-hospital cardiac arrest - an analysis of the TTM trial data.
abstract: Targeted temperature management is recommended after out-of-hospital cardiac arrest and may be achieved using a variety of cooling devices. This study was conducted to explore the performance and outcomes for intravascular versus surface devices for targeted temperature management after out-of-hospital cardiac arrest.
  
  
  
  A retrospective analysis of data from the Targeted Temperature Management trial. N = 934. A total of 240 patients (26%) managed with intravascular versus 694 (74%) with surface devices. Devices were assessed for speed and precision during the induction, maintenance and rewarming phases in addition to adverse events. All-cause mortality, as well as a composite of poor neurological function or death, as evaluated by the Cerebral Performance Category and modified Rankin scale were analysed.
  
  
  
  For patients managed at 33 °C there was no difference between intravascular and surface groups in the median time taken to achieve target temperature (210 [interquartile range (IQR) 180] minutes vs. 240 [IQR 180] minutes, p = 0.58), maximum rate of cooling (1.0 [0.7] vs. 1.0 [0.9] °C/hr, p = 0.44), the number of patients who reached target temperature (within 4 hours (65% vs. 60%, p = 0.30); or ever (100% vs. 97%, p = 0.47), or episodes of overcooling (8% vs. 34%, p = 0.15). In the maintenance phase, cumulative temperature deviation (median 3.2 [IQR 5.0] °C hr vs. 9.3 [IQR 8.0] °C hr, p = <0.001), number of patients ever out of range (57.0% vs. 91.5%, p = 0.006) and median time out of range (1 [IQR 4.0] hours vs. 8.0 [IQR 9.0] hours, p = <0.001) were all significantly greater in the surface group although there was no difference in the occurrence of pyrexia. Adverse events were not different between intravascular and surface groups. There was no statistically significant difference in mortality (intravascular 46.3% vs. surface 50.0%; p = 0.32), Cerebral Performance Category scale 3-5 (49.0% vs. 54.3%; p = 0.18) or modified Rankin scale 4-6 (49.0% vs. 53.0%; p = 0.48).
  
  
  
  Intravascular and surface cooling was equally effective during induction of mild hypothermia. However, surface cooling was associated with less precision during the maintenance phase. There was no difference in adverse events, mortality or poor neurological outcomes between patients treated with intravascular and surface cooling devices.
  
  
  
  TTM trial ClinicalTrials.gov number https://clinicaltrials.gov/ct2/show/NCT01020916 NCT01020916; 25 November 2009.
authors.affiliation: Department Intensive Care, Guy's and St Thomas' Hospital, King's College London, London, UK. guy.glover@gstt.nhs.uk.|Department of Critical Care, Guy's and St Thomas' NHS Foundation Trust, Kings Health Partners, Westminster Bridge Road, London, SE1 7EH, UK. guy.glover@gstt.nhs.uk.
authors.forename: Guy W
authors.initials: GW
authors.lastname: Glover
authors.affiliation: Department of Intensive Care, University College Hospital, London, UK.
authors.forename: Richard M
authors.initials: RM
authors.lastname: Thomas
authors.affiliation: Department of Biostatistics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
authors.forename: George
authors.initials: G
authors.lastname: Vamvakas
authors.affiliation: Department of Intensive Care, St George's Hospital, London, UK.
authors.forename: Nawaf
authors.initials: N
authors.lastname: Al-Subaie
authors.affiliation: Department of Intensive Care, Royal Bournemouth Hospital, Bournemouth, UK.
authors.forename: Jules
authors.initials: J
authors.lastname: Cranshaw
authors.affiliation: Department of Intensive Care, Royal Berkshire Hospital, Reading, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Walden
authors.affiliation: Adult Critical Care, University Hospital of Wales, Cardiff, UK.
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Wise
authors.affiliation: Department Intensive Care, Guy's and St Thomas' Hospital, King's College London, London, UK.
authors.forename: Marlies
authors.initials: M
authors.lastname: Ostermann
authors.affiliation: Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK.
authors.forename: Emma
authors.initials: E
authors.lastname: Thomas-Jones
authors.affiliation: Department of Neurology, Skåne University Hospital, Lund University, Lund, Sweden.
authors.forename: Tobias
authors.initials: T
authors.lastname: Cronberg
authors.affiliation: Department of Cardiology, Skåne University Hospital, Lund University, Lund, Sweden.
authors.forename: David
authors.initials: D
authors.lastname: Erlinge
authors.affiliation: Department of Intensive Care, Geneva University Hospital, Geneva, Switzerland.
authors.forename: Yvan
authors.initials: Y
authors.lastname: Gasche
authors.affiliation: The Heart Center, Copenhagen University Hospital, Righospitalet, Copenhagen, Denmark.
authors.forename: Christian
authors.initials: C
authors.lastname: Hassager
authors.affiliation: Department of Intensive Care, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Janneke
authors.initials: J
authors.lastname: Horn
authors.affiliation: The Heart Center, Copenhagen University Hospital, Righospitalet, Copenhagen, Denmark.
authors.forename: Jesper
authors.initials: J
authors.lastname: Kjaergaard
authors.affiliation: Department of Intensive Care, Medical Center Leeuwarden, Leeuwarden, The Netherlands.
authors.forename: Michael
authors.initials: M
authors.lastname: Kuiper
authors.affiliation: Department of Intensive Care, Santa Maria degli Ángeli, Pordenone, Italy.
authors.forename: Tommaso
authors.initials: T
authors.lastname: Pellis
authors.affiliation: Department of Anesthesiology and Intensive Care, Centre Hospitalier de Luxembourg, Luxembourg City, Luxembourg.
authors.forename: Pascal
authors.initials: P
authors.lastname: Stammet
authors.affiliation: The Heart Center, Copenhagen University Hospital, Righospitalet, Copenhagen, Denmark.
authors.forename: Michael
authors.initials: M
authors.lastname: Wanscher
authors.affiliation: Copenhagen Trial Unit, Center for Clinical Intervention Research, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Jørn
authors.initials: J
authors.lastname: Wetterslev
authors.affiliation: Department of Anesthesiology and Intensive Care, Skåne University Hospital, Lund University, Lund, Sweden.
authors.forename: Hans
authors.initials: H
authors.lastname: Friberg
authors.affiliation: Department of Anesthesiology and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden.
authors.forename: Niklas
authors.initials: N
authors.lastname: Nielsen
mesh_terms: D061605:Administration, Intravenous; D000368:Aged; D001830:Body Surface Area; D001831:Body Temperature / Q000502:physiology; D017679:Cryotherapy / Q000379:methods*; D019468:Disease Management; D005260:Female; D005334:Fever / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D007036:Hypothermia, Induced / Q000295:instrumentation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D012189:Retrospective Studies
keywords: Brain injuries; Critical care; Fever; Hypothermia; Induced; Out-of-hospital cardiac arrest; Shivering; Temperature