Evidence map›Paper›PMID 34389870›Full record

SynthesisIntensive care medicine2021

Targeted temperature management following out-of-hospital cardiac arrest: a systematic review and network meta-analysis of temperature targets.

Shannon M Fernando, Pietro Di Santo, Behnam Sadeghirad, Jean-Baptiste Lascarrou, Bram Rochwerg, Rebecca Mathew, Mypinder S Sekhon, Laveena Munshi, Eddy Fan, Daniel Brodie and 10 more

Abstract readSystematic ReviewNetwork Meta-Analysis
PubMed Publisher
In one paragraph

Synthesis in Intensive care medicine, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 50 papers, 5 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
50citing papers in PubMed, 5 pooled it
22.6field-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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

50 citing papers in PubMed, 5 syntheses or guidelines pooled it, 102 citations in OpenAlex.

  1. Hypothermia for neuroprotection in adults after cardiac arrest.The Cochrane database of systematic reviews · 2023
    Pooled it
  2. Pooled it
  3. Temperature control after cardiac arrest.Critical care (London, England) · 2022
    Pooled it
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  12. Management of non-Cardiac Organ Failure in cardiogenic shock.American heart journal plus : cardiology research and practice · 2025
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

20 authors at 12 institutions in 5 countries.

Shannon M FernandoDivision of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada. sfernando@qmed.ca.ORCID http://orcid.org/0000-0003-4549-4289
Pietro Di SantoCAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada.
Behnam SadeghiradDepartment of Anesthesia, McMaster University, Hamilton, ON, Canada.
Jean-Baptiste LascarrouService de Médecine Intensive Reanimation, Centre Hospitalier Universitaire Hôtel-Dieu, Nantes Cedex, France.
Bram RochwergDepartment of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
Rebecca MathewDivision of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
Mypinder S SekhonDivision of Critical Care Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
Laveena MunshiInterdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
Eddy FanInterdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
Daniel BrodieDivision of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA.
Kathryn M RowanIntensive Care National Audit and Research Centre, Napier House, London, UK.
Catherine L HoughDivision of Pulmonary and Critical Care Medicine, Oregon Health and Science University, Portland, OR, USA.
Shelley L McLeodDepartment of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
Christian VaillancourtDepartment of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada.
Sheldon CheskesDivision of Emergency Medicine, Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
Niall D FergusonInterdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
Damon C ScalesInterdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
Claudio SandroniInstitute of Anesthesiology and Intensive Care Medicine, Università Cattolica del Sacro Cuore, Rome, Italy.
Jerry P Nolan *Department of Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK.
Benjamin Hibbert *CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada.
University of Ottawa · CAUniversity Health Network · CAImpact · CASt. Michael's Hospital · CACentre Hospitalier Universitaire de Nantes · FRIntensive Care National Audit & Research Centre · GBNewYork–Presbyterian Hospital · USOregon Health & Science University · USRoyal United Hospital · GBUniversità Cattolica del Sacro Cuore · ITUniversity of British Columbia · CAUniversity of Toronto · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeTargeted temperature management (TTM) may improve survival and functional outcome in comatose survivors of out-of-hospital cardiac arrest (OHCA), though the optimal target temperature remains unknown. We conducted a systematic review and network meta-analysis to investigate the efficacy and safety of deep hypothermia (31-32 °C), moderate hypothermia (33-34 °C), mild hypothermia (35-36 °C), and normothermia (37-37.8 °C) during TTM.

methodsWe searched six databases from inception to June 2021 for randomized controlled trials (RCTs) evaluating TTM in comatose OHCA survivors. Two reviewers performed screening, full text review, and extraction independently. The primary outcome of interest was survival with good functional outcome. We used GRADE to rate our certainty in estimates.

resultsWe included 10 RCTs (4218 patients). Compared with normothermia, deep hypothermia (odds ratio [OR] 1.30, 95% confidence interval [CI] 0.73-2.30), moderate hypothermia (OR 1.34, 95% CI 0.92-1.94) and mild hypothermia (OR 1.44, 95% CI 0.74-2.80) may have no effect on survival with good functional outcome (all low certainty). Deep hypothermia may not improve survival with good functional outcome, as compared to moderate hypothermia (OR 0.97, 95% CI 0.61-1.54, low certainty). Moderate hypothermia (OR 1.23, 95% CI 0.86-1.77) and deep hypothermia (OR 1.27, 95% CI 0.70-2.32) may have no effect on survival, as compared to normothermia. Finally, incidence of arrhythmia was higher with moderate hypothermia (OR 1.45, 95% CI 1.08-1.94) and deep hypothermia (OR 3.58, 95% CI 1.77-7.26), compared to normothermia (both high certainty).

conclusionsMild, moderate, or deep hypothermia may not improve survival or functional outcome after OHCA, as compared to normothermia. Moderate and deep hypothermia were associated with higher incidence of arrhythmia. Routine use of moderate or deep hypothermia in comatose survivors of OHCA may potentially be associated with more harm than benefit.

Indexed as

Cardiopulmonary ResuscitationHypothermia, InducedOut-of-Hospital Cardiac ArrestComaHumansTemperatureTreatment OutcomeCritical care medicineEmergency medicineHypoxicIschemic brain injuryOut-of-hospital cardiac arrestTargeted temperature management

Identifiers

PMID34389870
OpenAlexW3189340594

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

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.