A Review published in Crit_Care discusses how twenty years after the publication of the first randomized trials on hypothermia after cardiac arrest, the protective role of temperature control for hypoxic-ischemic brain injury is still debated.
In the TTM-2 study, 1900 adults comatose after resuscitation from all-rhythm OHCA of presumed cardiac or unknown cause were randomized to temperature control at 33 °C or normothermia with early treatment of fever followed by temperature control at 37.5 °C []. After the intervention period of 40 h, normothermia was maintained until 72 h after randomization in patients who remained sedated or comatose. The primary outcome, 6-month mortality, was no different between the groups .
The TTM investigators have undertaken an individual patient data meta-analysis of the TTM-1 and TTM-2 studies []. Patients in the 36 °C group from TTM-1 were combined with those in the normothermia group in TTM-2 and were compared with the patients from the 33 °C groups in both TTM studies. The primary outcome, all-cause mortality at 6 months, occurred in 691 of 1398 participants in the 33 °C group and 666 of 1391 participants in the normothermia group .
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