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Prevention of Fever After Cardiac Arrest

Question Type:
Intervention
Full Question:
Among adults with ROSC after cardiac arrest in any setting  (P), does does prevention of fever to maintain strict normothermia  (I), compared with compared with no fever control  (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:
Fever After ROSC Without TTM For the critical outcomes of survival with good neurologic/functional outcome and/or survival only, we found very-low-quality evidence from 5 observational studies (downgraded for risk of bias and indirectness) that fever after ROSC is associated with poor outcome when TTM is not used.(Zeiner 2001, 2007; Langhelle 2003, 247; Nolan 2007, 1207; Suffoletto 2009, 1365; Gebhardt 2013, 1062) Fever After TTM For the critical outcomes of survival with good neurologic/functional outcome and/or survival only, we found very-low-quality evidence from 6 observational studies (n=856) (downgraded for risk of bias and indirectness) that fever after TTM is not associated with outcome.(Aldhoon 2012, e68; Benz-Woerner 2012, 338; Bouwes 2012, 996; Gebhardt 2013, 1062; Leary 2013, 1056; Cocchi 2014, 365) For the same critical outcomes, we also found very-low-quality evidence from 2 observational studies (n=411) (downgraded for risk of bias, inconsistency, and indirectness) that fever after TTM is associated with poor outcome.(Bro-Jeppesen 2013, 1734; Winters 2013, 1245)
Treatment Recommendation:
We suggest prevention and treatment of fever in persistently comatose adults after completion of TTM between 32°C and 36°C (weak recommendation, very-low-quality evidence). Values, Preferences, and Task Force Insights In making this recommendation, we recognize that TTM always should be used in comatose patients after cardiac arrest, and that fever will not occur during this time. Thus, fever management is primarily a concern after TTM has been completed. Despite substantial limitations of the included studies, expert opinion within the task force combined with the fact that fever prevention is common practice for other neurologic injuries in the ICU and the relative low risk of harm associated with fever prevention prompted us to recommend in favor of fever prevention.

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