Research
Print page Print page
Switch language
The Capital Region of Denmark - a part of Copenhagen University Hospital
Published

Hypothermia versus Normothermia after Out-of-Hospital Cardiac Arrest

Research output: Contribution to journalJournal articleResearchpeer-review

Harvard

Dankiewicz, J, Cronberg, T, Lilja, G, Jakobsen, JC, Levin, H, Ullén, S, Rylander, C, Wise, MP, Oddo, M, Cariou, A, Bělohlávek, J, Hovdenes, J, Saxena, M, Kirkegaard, H, Young, PJ, Pelosi, P, Storm, C, Taccone, FS, Joannidis, M, Callaway, C, Eastwood, GM, Morgan, MPG, Nordberg, P, Erlinge, D, Nichol, AD, Chew, MS, Hollenberg, J, Thomas, M, Bewley, J, Sweet, K, Grejs, AM, Christensen, S, Haenggi, M, Levis, A, Lundin, A, Düring, J, Schmidbauer, S, Keeble, TR, Karamasis, GV, Schrag, C, Faessler, E, Smid, O, Otáhal, M, Maggiorini, M, Wendel Garcia, PD, Jaubert, P, Cole, JM, Solar, M, Borgquist, O, Nielsen, N & TTM2 Trial Investigators 2021, 'Hypothermia versus Normothermia after Out-of-Hospital Cardiac Arrest', The New England journal of medicine, vol. 384, no. 24, pp. 2283-2294. https://doi.org/10.1056/NEJMoa2100591

APA

Dankiewicz, J., Cronberg, T., Lilja, G., Jakobsen, J. C., Levin, H., Ullén, S., Rylander, C., Wise, M. P., Oddo, M., Cariou, A., Bělohlávek, J., Hovdenes, J., Saxena, M., Kirkegaard, H., Young, P. J., Pelosi, P., Storm, C., Taccone, F. S., Joannidis, M., ... TTM2 Trial Investigators (2021). Hypothermia versus Normothermia after Out-of-Hospital Cardiac Arrest. The New England journal of medicine, 384(24), 2283-2294. https://doi.org/10.1056/NEJMoa2100591

CBE

Dankiewicz J, Cronberg T, Lilja G, Jakobsen JC, Levin H, Ullén S, Rylander C, Wise MP, Oddo M, Cariou A, Bělohlávek J, Hovdenes J, Saxena M, Kirkegaard H, Young PJ, Pelosi P, Storm C, Taccone FS, Joannidis M, Callaway C, Eastwood GM, Morgan MPG, Nordberg P, Erlinge D, Nichol AD, Chew MS, Hollenberg J, Thomas M, Bewley J, Sweet K, Grejs AM, Christensen S, Haenggi M, Levis A, Lundin A, Düring J, Schmidbauer S, Keeble TR, Karamasis GV, Schrag C, Faessler E, Smid O, Otáhal M, Maggiorini M, Wendel Garcia PD, Jaubert P, Cole JM, Solar M, Borgquist O, Nielsen N, TTM2 Trial Investigators. 2021. Hypothermia versus Normothermia after Out-of-Hospital Cardiac Arrest. The New England journal of medicine. 384(24):2283-2294. https://doi.org/10.1056/NEJMoa2100591

MLA

Vancouver

Author

Dankiewicz, Josef ; Cronberg, Tobias ; Lilja, Gisela ; Jakobsen, Janus C ; Levin, Helena ; Ullén, Susann ; Rylander, Christian ; Wise, Matt P ; Oddo, Mauro ; Cariou, Alain ; Bělohlávek, Jan ; Hovdenes, Jan ; Saxena, Manoj ; Kirkegaard, Hans ; Young, Paul J ; Pelosi, Paolo ; Storm, Christian ; Taccone, Fabio S ; Joannidis, Michael ; Callaway, Clifton ; Eastwood, Glenn M ; Morgan, Matt P G ; Nordberg, Per ; Erlinge, David ; Nichol, Alistair D ; Chew, Michelle S ; Hollenberg, Jacob ; Thomas, Matthew ; Bewley, Jeremy ; Sweet, Katie ; Grejs, Anders M ; Christensen, Steffen ; Haenggi, Matthias ; Levis, Anja ; Lundin, Andreas ; Düring, Joachim ; Schmidbauer, Simon ; Keeble, Thomas R ; Karamasis, Grigoris V ; Schrag, Claudia ; Faessler, Edith ; Smid, Ondrej ; Otáhal, Michal ; Maggiorini, Marco ; Wendel Garcia, Pedro D ; Jaubert, Paul ; Cole, Jade M ; Solar, Miroslav ; Borgquist, Ola ; Nielsen, Niklas ; TTM2 Trial Investigators. / Hypothermia versus Normothermia after Out-of-Hospital Cardiac Arrest. In: The New England journal of medicine. 2021 ; Vol. 384, No. 24. pp. 2283-2294.

Bibtex

@article{f66874dc62594102a69111b85d198227,
title = "Hypothermia versus Normothermia after Out-of-Hospital Cardiac Arrest",
abstract = "BACKGROUND: Targeted temperature management is recommended for patients after cardiac arrest, but the supporting evidence is of low certainty.METHODS: In an open-label trial with blinded assessment of outcomes, we randomly assigned 1900 adults with coma who had had an out-of-hospital cardiac arrest of presumed cardiac or unknown cause to undergo targeted hypothermia at 33°C, followed by controlled rewarming, or targeted normothermia with early treatment of fever (body temperature, ≥37.8°C). The primary outcome was death from any cause at 6 months. Secondary outcomes included functional outcome at 6 months as assessed with the modified Rankin scale. Prespecified subgroups were defined according to sex, age, initial cardiac rhythm, time to return of spontaneous circulation, and presence or absence of shock on admission. Prespecified adverse events were pneumonia, sepsis, bleeding, arrhythmia resulting in hemodynamic compromise, and skin complications related to the temperature management device.RESULTS: A total of 1850 patients were evaluated for the primary outcome. At 6 months, 465 of 925 patients (50%) in the hypothermia group had died, as compared with 446 of 925 (48%) in the normothermia group (relative risk with hypothermia, 1.04; 95% confidence interval [CI], 0.94 to 1.14; P = 0.37). Of the 1747 patients in whom the functional outcome was assessed, 488 of 881 (55%) in the hypothermia group had moderately severe disability or worse (modified Rankin scale score ≥4), as compared with 479 of 866 (55%) in the normothermia group (relative risk with hypothermia, 1.00; 95% CI, 0.92 to 1.09). Outcomes were consistent in the prespecified subgroups. Arrhythmia resulting in hemodynamic compromise was more common in the hypothermia group than in the normothermia group (24% vs. 17%, P<0.001). The incidence of other adverse events did not differ significantly between the two groups.CONCLUSIONS: In patients with coma after out-of-hospital cardiac arrest, targeted hypothermia did not lead to a lower incidence of death by 6 months than targeted normothermia. (Funded by the Swedish Research Council and others; TTM2 ClinicalTrials.gov number, NCT02908308.).",
keywords = "Aged, Body Temperature, Cardiopulmonary Resuscitation/methods, Coma/etiology, Female, Fever/etiology, Humans, Hypothermia, Induced/adverse effects, Kaplan-Meier Estimate, Male, Middle Aged, Out-of-Hospital Cardiac Arrest/complications, Single-Blind Method, Treatment Outcome",
author = "Josef Dankiewicz and Tobias Cronberg and Gisela Lilja and Jakobsen, {Janus C} and Helena Levin and Susann Ull{\'e}n and Christian Rylander and Wise, {Matt P} and Mauro Oddo and Alain Cariou and Jan B{\v e}lohl{\'a}vek and Jan Hovdenes and Manoj Saxena and Hans Kirkegaard and Young, {Paul J} and Paolo Pelosi and Christian Storm and Taccone, {Fabio S} and Michael Joannidis and Clifton Callaway and Eastwood, {Glenn M} and Morgan, {Matt P G} and Per Nordberg and David Erlinge and Nichol, {Alistair D} and Chew, {Michelle S} and Jacob Hollenberg and Matthew Thomas and Jeremy Bewley and Katie Sweet and Grejs, {Anders M} and Steffen Christensen and Matthias Haenggi and Anja Levis and Andreas Lundin and Joachim D{\"u}ring and Simon Schmidbauer and Keeble, {Thomas R} and Karamasis, {Grigoris V} and Claudia Schrag and Edith Faessler and Ondrej Smid and Michal Ot{\'a}hal and Marco Maggiorini and {Wendel Garcia}, {Pedro D} and Paul Jaubert and Cole, {Jade M} and Miroslav Solar and Ola Borgquist and Niklas Nielsen and {TTM2 Trial Investigators}",
note = "Copyright {\textcopyright} 2021 Massachusetts Medical Society.",
year = "2021",
month = jun,
day = "17",
doi = "10.1056/NEJMoa2100591",
language = "English",
volume = "384",
pages = "2283--2294",
journal = "New England Journal of Medicine",
issn = "0028-4793",
publisher = "Massachusetts Medical Society",
number = "24",

}

RIS

TY - JOUR

T1 - Hypothermia versus Normothermia after Out-of-Hospital Cardiac Arrest

AU - Dankiewicz, Josef

AU - Cronberg, Tobias

AU - Lilja, Gisela

AU - Jakobsen, Janus C

AU - Levin, Helena

AU - Ullén, Susann

AU - Rylander, Christian

AU - Wise, Matt P

AU - Oddo, Mauro

AU - Cariou, Alain

AU - Bělohlávek, Jan

AU - Hovdenes, Jan

AU - Saxena, Manoj

AU - Kirkegaard, Hans

AU - Young, Paul J

AU - Pelosi, Paolo

AU - Storm, Christian

AU - Taccone, Fabio S

AU - Joannidis, Michael

AU - Callaway, Clifton

AU - Eastwood, Glenn M

AU - Morgan, Matt P G

AU - Nordberg, Per

AU - Erlinge, David

AU - Nichol, Alistair D

AU - Chew, Michelle S

AU - Hollenberg, Jacob

AU - Thomas, Matthew

AU - Bewley, Jeremy

AU - Sweet, Katie

AU - Grejs, Anders M

AU - Christensen, Steffen

AU - Haenggi, Matthias

AU - Levis, Anja

AU - Lundin, Andreas

AU - Düring, Joachim

AU - Schmidbauer, Simon

AU - Keeble, Thomas R

AU - Karamasis, Grigoris V

AU - Schrag, Claudia

AU - Faessler, Edith

AU - Smid, Ondrej

AU - Otáhal, Michal

AU - Maggiorini, Marco

AU - Wendel Garcia, Pedro D

AU - Jaubert, Paul

AU - Cole, Jade M

AU - Solar, Miroslav

AU - Borgquist, Ola

AU - Nielsen, Niklas

AU - TTM2 Trial Investigators

N1 - Copyright © 2021 Massachusetts Medical Society.

PY - 2021/6/17

Y1 - 2021/6/17

N2 - BACKGROUND: Targeted temperature management is recommended for patients after cardiac arrest, but the supporting evidence is of low certainty.METHODS: In an open-label trial with blinded assessment of outcomes, we randomly assigned 1900 adults with coma who had had an out-of-hospital cardiac arrest of presumed cardiac or unknown cause to undergo targeted hypothermia at 33°C, followed by controlled rewarming, or targeted normothermia with early treatment of fever (body temperature, ≥37.8°C). The primary outcome was death from any cause at 6 months. Secondary outcomes included functional outcome at 6 months as assessed with the modified Rankin scale. Prespecified subgroups were defined according to sex, age, initial cardiac rhythm, time to return of spontaneous circulation, and presence or absence of shock on admission. Prespecified adverse events were pneumonia, sepsis, bleeding, arrhythmia resulting in hemodynamic compromise, and skin complications related to the temperature management device.RESULTS: A total of 1850 patients were evaluated for the primary outcome. At 6 months, 465 of 925 patients (50%) in the hypothermia group had died, as compared with 446 of 925 (48%) in the normothermia group (relative risk with hypothermia, 1.04; 95% confidence interval [CI], 0.94 to 1.14; P = 0.37). Of the 1747 patients in whom the functional outcome was assessed, 488 of 881 (55%) in the hypothermia group had moderately severe disability or worse (modified Rankin scale score ≥4), as compared with 479 of 866 (55%) in the normothermia group (relative risk with hypothermia, 1.00; 95% CI, 0.92 to 1.09). Outcomes were consistent in the prespecified subgroups. Arrhythmia resulting in hemodynamic compromise was more common in the hypothermia group than in the normothermia group (24% vs. 17%, P<0.001). The incidence of other adverse events did not differ significantly between the two groups.CONCLUSIONS: In patients with coma after out-of-hospital cardiac arrest, targeted hypothermia did not lead to a lower incidence of death by 6 months than targeted normothermia. (Funded by the Swedish Research Council and others; TTM2 ClinicalTrials.gov number, NCT02908308.).

AB - BACKGROUND: Targeted temperature management is recommended for patients after cardiac arrest, but the supporting evidence is of low certainty.METHODS: In an open-label trial with blinded assessment of outcomes, we randomly assigned 1900 adults with coma who had had an out-of-hospital cardiac arrest of presumed cardiac or unknown cause to undergo targeted hypothermia at 33°C, followed by controlled rewarming, or targeted normothermia with early treatment of fever (body temperature, ≥37.8°C). The primary outcome was death from any cause at 6 months. Secondary outcomes included functional outcome at 6 months as assessed with the modified Rankin scale. Prespecified subgroups were defined according to sex, age, initial cardiac rhythm, time to return of spontaneous circulation, and presence or absence of shock on admission. Prespecified adverse events were pneumonia, sepsis, bleeding, arrhythmia resulting in hemodynamic compromise, and skin complications related to the temperature management device.RESULTS: A total of 1850 patients were evaluated for the primary outcome. At 6 months, 465 of 925 patients (50%) in the hypothermia group had died, as compared with 446 of 925 (48%) in the normothermia group (relative risk with hypothermia, 1.04; 95% confidence interval [CI], 0.94 to 1.14; P = 0.37). Of the 1747 patients in whom the functional outcome was assessed, 488 of 881 (55%) in the hypothermia group had moderately severe disability or worse (modified Rankin scale score ≥4), as compared with 479 of 866 (55%) in the normothermia group (relative risk with hypothermia, 1.00; 95% CI, 0.92 to 1.09). Outcomes were consistent in the prespecified subgroups. Arrhythmia resulting in hemodynamic compromise was more common in the hypothermia group than in the normothermia group (24% vs. 17%, P<0.001). The incidence of other adverse events did not differ significantly between the two groups.CONCLUSIONS: In patients with coma after out-of-hospital cardiac arrest, targeted hypothermia did not lead to a lower incidence of death by 6 months than targeted normothermia. (Funded by the Swedish Research Council and others; TTM2 ClinicalTrials.gov number, NCT02908308.).

KW - Aged

KW - Body Temperature

KW - Cardiopulmonary Resuscitation/methods

KW - Coma/etiology

KW - Female

KW - Fever/etiology

KW - Humans

KW - Hypothermia, Induced/adverse effects

KW - Kaplan-Meier Estimate

KW - Male

KW - Middle Aged

KW - Out-of-Hospital Cardiac Arrest/complications

KW - Single-Blind Method

KW - Treatment Outcome

UR - http://www.scopus.com/inward/record.url?scp=85108262132&partnerID=8YFLogxK

U2 - 10.1056/NEJMoa2100591

DO - 10.1056/NEJMoa2100591

M3 - Journal article

C2 - 34133859

VL - 384

SP - 2283

EP - 2294

JO - New England Journal of Medicine

JF - New England Journal of Medicine

SN - 0028-4793

IS - 24

ER -

ID: 67053236