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Duration of TTM

Question Type:
Intervention
Full Question:
In patients with ROSC after cardiac arrest in any setting  (P), does does induction and maintenance of hypothermia for any duration other than 24 hours  (I), compared with compared with induction and maintenance of hypothermia for a duration of 24 hours  (C), change Survival with Favorable neurological/functional outcome at discharge, 30 days, 60 days, 180 days AND/OR 1 year, Survival only at discharge, 30 days, 60 days, 180 days AND/OR 1 year (O)?
Consensus on Science:
We found no human trials comparing different durations of TTM after cardiac arrest. For the critical outcome of favorable neurologic outcome, very-low-quality evidence (downgraded for risk of bias and imprecision) from 2 observational trials found no difference in duration of hypothermia(Yokoyama 2011, 1063) and no difference in mortality or poor neurologic outcome with 24 hours compared with 72 hours of hypothermia.(Lee 2014, 297) Previous trials treated patients with 12 to 28 hours of TTM.(2002, 549; Bernard 2002, 557; Nielsen 2013, 2197) One trial provided strict normothermia (less than 37.5°C) after hypothermia until 72 hours after ROSC.(Nielsen 2013, 2197)
Treatment Recommendation:
We suggest that if TTM is used, duration should be at least 24 hours, as done in the 2 largest previous RCTs(HACA Study Group 2002, 549; Nielsen 2013, 2197) (weak recommendation, very-low-quality evidence). Values, Preferences, and Task Force Insights In making this recommendation, we place a high value on not changing current clinical practice, which most commonly is a TTM duration of 24 hours. We further note that the 2 largest trials related to TTM both used at least 24 hours, one of which found an outcome benefit when compared with not using TTM.
CoSTR Attachments:
Temperature Management After Cardiac Arrest. Article.pdf    
Temperature Management After Cardiac Arrest. Data Supplement.pdf    

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