Evidence map›Paper›PMID 24237006›Full record

Trial reportThe New England journal of medicine2013

Targeted temperature management at 33°C versus 36°C after cardiac arrest.

Niklas Nielsen, Jørn Wetterslev, Tobias Cronberg, David Erlinge, Yvan Gasche, Christian Hassager, Janneke Horn, Jan Hovdenes, Jesper Kjaergaard, Michael Kuiper and 24 more

8 registry-linked trialsOpen access · bronzeAbstract readMulticenter StudyRandomized Controlled Trial
PubMed Publisher
In one paragraph

Trial report in The New England journal of medicine, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 8 registered trials, which are not on this map. Cited by 949 papers, 11 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
949citing papers in PubMed, 11 pooled it
263.4field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT01020916 nacompletednot on this map

Target Temperature Management 33°C Versus 36°C After Out-of-hospital Cardiac Arrest, a Randomised, Parallel Groups, Assessor Blinded Clinical Trial

TypeinterventionalSponsorNiklas NielsenRan2010 to 2013Enrolled950ConditionsOut-of-hospital Cardiac ArrestArmsTarget temperature 36°C, Target Temperature 33°C
NCT02634411 nacompletednot on this mapstarted 2016, after this paper: background citation

Impact of the Duration of Antibiotics on Clinical Events in Patients With Pseudomonas Aeruginosa Ventilator-associated Pneumonia : a Randomized Controlled Study (iDIAPASON)

TypeinterventionalSponsorAssistance Publique - Hôpitaux de ParisRan2016 to 2018Enrolled190ConditionsVentilator-Associated PneumoniaArms8 days of effective antibiotic treatment, 15 days of effective antibiotic treatment
NCT02889744 naunknown statusnot on this mapstarted 2016, after this paper: background citation

Comparison of Cerebral Tissue Oxygen Saturation (SctO2) Between 36℃ and 33℃ of Targeted Temperature Management (TTM) After Cardiac Arrest

TypeinterventionalSponsorSeoul National University HospitalRan2016 to 2021Enrolled66ConditionsHeart ArrestArmsArctic Sun
NCT02908308 nacompletednot on this mapstarted 2017, after this paper: background citation

Targeted Hypothermia Versus Targeted Normothermia After Out-of-hospital Cardiac Arrest (TTM2) - A Randomised Clinical Trial

TypeinterventionalSponsorHelsingborgs HospitalRan2017 to 2022Enrolled1,900ConditionsOut-of-hospital Cardiac ArrestArmsTargeted temperature management to 33°C, Standard care with early treatment of fever
NCT03829215 nawithdrawnnot on this mapstarted 2022, after this paper: background citation

Prehospital Cooling of Comatose Patients After Cardiac Arrest With a Non-invasive, Unpowered Core Body Cooling Device (CAERVest Prehospital Cooling)

TypeinterventionalSponsorMedical University of ViennaRan2022 to 2022Enrolled0ConditionsCardiac Arrest, Postresuscitation EncephalopathyArmsCAERVest cooling device
NCT06540768 nanot yet recruitingnot on this mapstarted 2025, after this paper: background citation

Therapeutic Normothermia in the Treatment of Traumatic Brain Injury Trial: Feasibility Trial

TypeinterventionalSponsorLondon Health Sciences CentreRan2025 to 2025Enrolled50ConditionsTraumatic Brain InjuryArmsTherapeutic Normothermia Group
NCT07017374 active not recruitingnot on this mapstarted 2025, after this paper: background citation

Proteomic Analysis of Serum Samples After Cardiac Arrest: a TTM-trial Substudy

TypeobservationalSponsorRegion SkaneRan2025 to 2026Enrolled682ConditionsCardiac Arrest (CA), ProteomicsArmsProteomic analysis, targeted temperature management
NCT07421882 narecruitingnot on this mapstarted 2026, after this paper: background citation

PRE-hospital Cooling to improvE carDiac arrEst Neurological outComEs (PRECEDENCE): a Pilot Feasibility Study

TypeinterventionalSponsorSingapore General HospitalRan2026 to 2027Enrolled50ConditionsOut-Of-Hospital Cardiac Arrest, Cardiopulmonary Resuscitation, Death, Sudden, Cardiac, Therapeutic HypothermiaArmsCarbonCool® Cooling Vest
3 · Its place in the literature

Who cites it

949 citing papers in PubMed, 11 syntheses or guidelines pooled it, 2,742 citations in OpenAlex.

  1. Pooled it
  2. Guideline
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  5. Impact of Mild Hypothermia As Adjunctive Therapy in Patients With ST-Elevation Myocardial Infarction: A Meta-Analysis and Trial Sequential Analysis of Randomized Controlled Trials.Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions · 2025
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  10. Guideline
  11. Hypothermia for neuroprotection in adults after cardiac arrest.The Cochrane database of systematic reviews · 2023
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889 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

34 authors at 14 institutions in 9 countries.

Niklas NielsenThe authors' affiliations are listed in the Appendix.
Jørn Wetterslev
Tobias Cronberg
David Erlinge
Yvan Gasche
Christian Hassager
Janneke Horn
Jan Hovdenes
Jesper Kjaergaard
Michael Kuiper
Tommaso Pellis
Pascal Stammet
Michael Wanscher
Matt P Wise
Anders Åneman
Nawaf Al-Subaie
Søren Boesgaard
John Bro-Jeppesen
Iole Brunetti
Jan Frederik Bugge
Christopher D Hingston
Nicole P Juffermans
Matty Koopmans
Lars Køber
Jørund Langørgen
Gisela Lilja
Jacob Eifer Møller
Malin Rundgren
Christian Rylander
Ondrej Smid
Christophe Werer
Per Winkel
Hans Friberg
TTM Trial Investigators
Skåne University Hospital · SECopenhagen University Hospital · DKAcademic Medical Center · NLCentre Hospitalier de Luxembourg · LUMedisch Centrum Leeuwarden · NLOslo University Hospital · NORigshospitalet · DKUniversity Hospital of Wales · GBAzienda Ospedaliera Santa Maria Degli Angeli · ITGeneral University Hospital in Prague · CZHaukeland University Hospital · NOSahlgrenska University Hospital · SEUniversity Hospital of Geneva · CHUniversity of Genoa · IT

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundUnconscious survivors of out-of-hospital cardiac arrest have a high risk of death or poor neurologic function. Therapeutic hypothermia is recommended by international guidelines, but the supporting evidence is limited, and the target temperature associated with the best outcome is unknown. Our objective was to compare two target temperatures, both intended to prevent fever.

methodsIn an international trial, we randomly assigned 950 unconscious adults after out-of-hospital cardiac arrest of presumed cardiac cause to targeted temperature management at either 33°C or 36°C. The primary outcome was all-cause mortality through the end of the trial. Secondary outcomes included a composite of poor neurologic function or death at 180 days, as evaluated with the Cerebral Performance Category (CPC) scale and the modified Rankin scale.

resultsIn total, 939 patients were included in the primary analysis. At the end of the trial, 50% of the patients in the 33°C group (235 of 473 patients) had died, as compared with 48% of the patients in the 36°C group (225 of 466 patients) (hazard ratio with a temperature of 33°C, 1.06; 95% confidence interval [CI], 0.89 to 1.28; P=0.51). At the 180-day follow-up, 54% of the patients in the 33°C group had died or had poor neurologic function according to the CPC, as compared with 52% of patients in the 36°C group (risk ratio, 1.02; 95% CI, 0.88 to 1.16; P=0.78). In the analysis using the modified Rankin scale, the comparable rate was 52% in both groups (risk ratio, 1.01; 95% CI, 0.89 to 1.14; P=0.87). The results of analyses adjusted for known prognostic factors were similar.

conclusionsIn unconscious survivors of out-of-hospital cardiac arrest of presumed cardiac cause, hypothermia at a targeted temperature of 33°C did not confer a benefit as compared with a targeted temperature of 36°C. (Funded by the Swedish Heart-Lung Foundation and others; TTM ClinicalTrials.gov number, NCT01020916.).

Indexed as

Hypothermia, InducedAdultAgedBody TemperatureCardiopulmonary ResuscitationFemaleFollow-Up StudiesHumansKaplan-Meier EstimateMaleMiddle AgedModels, StatisticalOut-of-Hospital Cardiac ArrestTreatment FailureUnconsciousnessWithholding Treatment

Identifiers

PMID24237006
OpenAlexW2171886225

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

and 2 more above

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.