1 / 15

Niklas Nielsen, MD, PhD, EDIC, DEAA Helsingborg Hospital Lund University Sweden

Targeted Temperature Management 33°C versus 36°C after Cardiac Arrest TTM-trial investigators. Niklas Nielsen, MD, PhD, EDIC, DEAA Helsingborg Hospital Lund University Sweden . Hypothermia to 32-34°C after out - of -hospital cardiac arrest is recommended in guidelines

denise
Download Presentation

Niklas Nielsen, MD, PhD, EDIC, DEAA Helsingborg Hospital Lund University Sweden

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Targeted Temperature Management 33°C versus 36°C after Cardiac Arrest TTM-trial investigators Niklas Nielsen, MD, PhD, EDIC, DEAA Helsingborg Hospital Lund University Sweden

  2. Hypothermiato 32-34°C afterout-of-hospital cardiac arrest is recommended in guidelines • The overall qualityofevidence for temperature management is lowaccordingto GRADE • The optimal targettemperature has not yetbeendetermined Nielsen et al. Int J Card 2010

  3. Main objective • To assess the benefits and harms of a targeted temperature management at 33°C versus 36°C • Avoiding fever in post-cardiac arrest patients in both groups

  4. TTM-trial – 2010-2013 • 950 patients randomized • 36 hospitals • 10 countries • Europe and Australia • Funded by: • Swedish Heart Lung Foundation • AFA-insurance Foundation, Sweden • Swedish Research Council • Governmental and Regional funding within the Swedish National Health System • TrygFoundation, Denmark • Zoega, Krapperup, Thure Carlsson, Trolle-Wachtmeister foundations, Sweden

  5. Design and timeline • Temperature intervention 36 hours • All patients sedated and ventilated minimum 36 hours • Feed-back controlled cooling devices in all patients • Intravascular or surface devices Inclusion 240 min Prognostication Half year follow up 36 h 180 days 956 d 72 hours ROSC Intervention ICU, hospital discharge

  6. Methodological design • 20% Hazard ratio reduction • 5% α, 90% predicted power • Standardized rules for prognostication • Standardized rules for withdrawal of life support • Blinded prognostication • Blinded outcome assessment • External monitoring

  7. Inclusioncriteria • Out-of-hospital cardiac arrest • Adult (18 years and over) • Presumed cardiac cause • All initial rhythms • Unconscious (Glasgow Coma Scale < 8) • Stable Return of Spontaneous Circulation

  8. Main exclusioncriteria • Unwitnessed arrest with initial rhythm asystole • >240 minutes from Return of Circulation • Body temperature below 30°C • Known or suspected intracranial hemorrhage and stroke

  9. Outcomes • Primary outcome: Survival • Secondary outcomes: • Mortality and poor neurological function at 180 days • Cerebral Performance Category • Modified Rankin Scale • Serious adverse events

  10. Baseline characteristics

  11. Temperature profileMean ± 2SD °Celcius P<0.0001 Hours

  12. Survival P=0.51 No difference in survival

  13. Outcomes 100% follow-up 99% follow-up

  14. Subgroups Results consistent in pre-defined subgroups

  15. Conclusion • In unconscious survivors of out-of-hospital cardiac arrest of presumed cardiac cause targeting a temperature of 33°C did not confer any benefit compared to targeting a temperature of 36°C

More Related