Various methods have been used to control body temperature in targeted temperature management (TTM), but few studies have compared specific subtypes of surface cooling systems. The aim of this study was to compare the efficiencies and neurological outcomes between hydrogels pad and water-circulating blanket cooling methods.
We conducted a multicentre, prospective, registry-based study of out-of-hospital cardiac arrest patients treated with TTM between 2015 and 2018. We compared the neurological outcomes, efficacies for cooling, and adverse events between patients who received TTM using a hydrogel pad and water-circulating blanket cooling. Patients were one-to-one matched using propensity scores to adjust for differences in the baseline characteristics of each cooling method. The primary outcome was a favourable neurological outcome at 6 months.
We included 1,132 patients in the analysis, 870 of whom underwent hydrogel pad cooling, and the remaining 262 underwent water-circulating blanket cooling. In the unmatched cohort, a greater number of adverse events occurred in the water-circulating blanket group. The favourable neurologic outcome rates at 6 months were similar between the hydrogel pad group and the water circulating blanket group (30.2% vs. 29.8%, p = 0.939). In the propensity-matched cohort, which included 184 pairs, the rates of adverse events between the two groups were similar. The similarity of favourable neurologic outcome rates at 6 months between the two groups persisted (28.8% vs. 29.9%, p = 0.819).
Neurological outcomes and adverse events between the hydrogel pad cooling and water-circulating blanket cooling groups were similar.
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- Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.Circulation. 2020; 142: S366-S468
- European Resuscitation Council Guidelines 2021: Cardiac arrest in special circumstances.Resuscitation. 2021; 161: 152-219
- 2020 Korean Guidelines for Cardiopulmonary Resuscitation. Part 3. Adult basic life support. Clin Exp.Emerg Med. 2021; 8: S15-S25
- Endovascular Versus External Targeted Temperature Management for Patients With Out-of-Hospital Cardiac Arrest: A Randomized, Controlled Study.Circulation. 2015; 132: 182-193
- Rapid Infusion of Cold Hartmanns (RICH) Investigators. Induction of prehospital therapeutic hypothermia after resuscitation from nonventricular fibrillation cardiac arrest.Crit Care Med. 2012; 40: 747-753
- Therapeutic hypothermia and controlled normothermia in the intensive care unit: practical considerations, side effects, and cooling methods.Crit Care Med. 2009; 37: 1101-1120
- Surface cooling with a new cooling blanket for rapid induction of mild hypothermia in humans after cardiac arrest: a feasibility trial.Resuscitation. 2006; 69: 93
- A prospective, multicentre pilot study to evaluate the feasibility and safety of using the CoolGuard System and Icy catheter following cardiac arrest.Resuscitation. 2004; 62: 143-150
- Equipment review: cooling catheters to induce therapeutic hypothermia?.Crit Care. 2006; 10: 234
- Safety and efficacy of a novel intravascular cooling device to control body temperature in neurologic intensive care patients: a prospective pilot study.Crit Care Med. 2002; 30: 2481-2488
- Effect of different methods of cooling for targeted temperature management on outcome after cardiac arrest: a systematic review and meta-analysis.Crit Care. 2019; 23: 285
- Effects of endovascular and surface cooling on resuscitation in patients with cardiac arrest and a comparison of effectiveness, stability, and safety: a systematic review and meta-analysis.Crit Care. 2020; 24: 27
- Systematic review and meta-analysis of intravascular temperature management vs. surface cooling in comatose patients resuscitated from cardiac arrest.Resuscitation. 2020; 146: 82-95
- A comparison of intravascular and surface cooling devices for targeted temperature management after out-of-hospital cardiac arrest: A nationwide observational study.Medicine (Baltimore). 2019; 98e16549
- Intravascular versus surface cooling for targeted temperature management after out-of-hospital cardiac arrest: an analysis of the TTH48 trial.Crit Care. 2019; 23: 61
- Intravascular versus surface cooling for targeted temperature management after out-of-hospital cardiac arrest - an analysis of the TTM trial data.Crit Care. 2016; 20: 381
- A randomized controlled trial comparing the Arctic Sun to standard cooling for induction of hypothermia after cardiac arrest.Resuscitation. 2010; 81: 9-14
- Usefulness of a surface cooling device (Arctic Sun®) for therapeutic hypothermia following cardiac arrest.J Cardiol. 2014; 63: 46-52
- Comparison between Gel Pad Cooling Device and Water Blanket during Target Temperature Management in Cardiac Arrest Patients.Acute Crit Care. 2018; 33: 246-251
- Combination of neuron-specific enolase measurement and initial neurological examination for the prediction of neurological outcomes after cardiac arrest.Sci Rep. 2021; 11: 15067
- Is this patient dead, vegetative, or severely neurologically impaired? Assessing outcome for comatose survivors of cardiac arrest.JAMA. 2004; 291: 870-879
- An observational study of surface versus endovascular cooling techniques in cardiac arrest patients: a propensity-matched analysis.Crit Care. 2015; 19: 85
- Targeted temperature management at 33°C versus 36°C after cardiac arrest.N Engl J Med. 2013; 369: 2197-2206
- Hypothermia versus Normothermia after Out-of-Hospital Cardiac Arrest.N Engl J Med. 2021; 384: 2283-2294
- High Quality Targeted Temperature Management (TTM) After Cardiac Arrest.Crit Care. 2020; 24: 6
- Quality of targeted temperature management and outcome of out-of-hospital cardiac arrest patients: A post hoc analysis of the TTH48 study.Resuscitation. 2021; 165: 85-92
- Relationship between timing of cooling and outcomes in adult comatose cardiac arrest patients treated with targeted temperature management.Resuscitation. 2017; 113: 135-141
- Door-to-Targeted Temperature Management Initiation Time and Outcomes in Out-of-Hospital Cardiac Arrest: Insights From the Continuous Chest Compressions Trial.J Am Heart Assoc. 2019; 8e012001
- Effect of prehospital induction of mild hypothermia on survival and neurological status among adults with cardiac arrest: a randomized clinical trial.JAMA. 2014; 311: 45-52
- Effect of Trans-Nasal Evaporative Intra-arrest Cooling on Functional Neurologic Outcome in Out-of-Hospital Cardiac Arrest: The PRINCESS Randomized Clinical Trial.JAMA. 2019; 321: 1677-1685
Published online: October 19, 2021
Accepted: October 11, 2021
Received in revised form: October 8, 2021
Received: September 9, 2021
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