Helena Stockmann1, Alexander Krannich2, Tim Schroeder3, Christian Storm3. 1. Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Department of Nephrology and Medical Intensive Care Medicine, Augustenburger Platz 1, 13353 Berlin, Germany. Electronic address: helena.stockmann@charite.de. 2. Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Coordination Center for Clinical Trials, Department of Biostatistics, Augustenburger Platz 1, 13353 Berlin, Germany. 3. Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Department of Nephrology and Medical Intensive Care Medicine, Augustenburger Platz 1, 13353 Berlin, Germany.
Abstract
AIM: Prognosis after cardiac arrest in the era of modern critical care is still poor with a high mortality of approximately 90%. Around 30% of the survivors have neurological impairments. Targeted temperature management (TTM) is the only treatment option which can improve mortality and neurological outcome. It is so far unclear if bleeding complications occur more often in patients undergoing TTM treatment. METHODS: We conducted a systematic literature research in September 2013 including three major databases i.e. MEDLINE, EMBASE and CENTRAL. All studies were rated in respect to the ILCOR Guidelines and concerning their level of evidence and quality. We then performed a meta-analysis on bleeding disposition under TTM. RESULTS: We initially found 941 studies out of which 34 matched our requirements and were thus included in our overview. Five studies including 599 patients were summarized in a meta-analysis concerning bleeding complications of all severities. There was a trend toward higher bleeding in patients treated with TTM (RR: 1.30, 95% CI: 0.97-1.74) which did not reach significance (p=0.085). Seven studies with an overall 599 patients were included in our meta-analysis on bleeding requiring transfusion. There was no significant difference in the incidence of severe bleeding with a risk ratio of 0.97 (95% CI: 0.61-1.56, p=0.909). CONCLUSIONS: The data included in our meta-analysis indicate that, concerning the risk of bleeding, TTM is a safe method for patients after cardiac arrest. We did not observe a significantly higher risk for bleeding in patients undergoing TTM.
AIM: Prognosis after cardiac arrest in the era of modern critical care is still poor with a high mortality of approximately 90%. Around 30% of the survivors have neurological impairments. Targeted temperature management (TTM) is the only treatment option which can improve mortality and neurological outcome. It is so far unclear if bleeding complications occur more often in patients undergoing TTM treatment. METHODS: We conducted a systematic literature research in September 2013 including three major databases i.e. MEDLINE, EMBASE and CENTRAL. All studies were rated in respect to the ILCOR Guidelines and concerning their level of evidence and quality. We then performed a meta-analysis on bleeding disposition under TTM. RESULTS: We initially found 941 studies out of which 34 matched our requirements and were thus included in our overview. Five studies including 599 patients were summarized in a meta-analysis concerning bleeding complications of all severities. There was a trend toward higher bleeding in patients treated with TTM (RR: 1.30, 95% CI: 0.97-1.74) which did not reach significance (p=0.085). Seven studies with an overall 599 patients were included in our meta-analysis on bleeding requiring transfusion. There was no significant difference in the incidence of severe bleeding with a risk ratio of 0.97 (95% CI: 0.61-1.56, p=0.909). CONCLUSIONS: The data included in our meta-analysis indicate that, concerning the risk of bleeding, TTM is a safe method for patients after cardiac arrest. We did not observe a significantly higher risk for bleeding in patients undergoing TTM.
Authors: Young-Min Kim; Chun Song Youn; Soo Hyun Kim; Byung Kook Lee; In Soo Cho; Gyu Chong Cho; Kyung Woon Jeung; Sang Hoon Oh; Seung Pill Choi; Jong Hwan Shin; Kyoung-Chul Cha; Joo Suk Oh; Hyeon Woo Yim; Kyu Nam Park Journal: Crit Care Date: 2015-07-22 Impact factor: 9.097
Authors: Behnood Bikdeli; Mahesh V Madhavan; David Jimenez; Taylor Chuich; Isaac Dreyfus; Elissa Driggin; Caroline Der Nigoghossian; Walter Ageno; Mohammad Madjid; Yutao Guo; Liang V Tang; Yu Hu; Jay Giri; Mary Cushman; Isabelle Quéré; Evangelos P Dimakakos; C Michael Gibson; Giuseppe Lippi; Emmanuel J Favaloro; Jawed Fareed; Joseph A Caprini; Alfonso J Tafur; John R Burton; Dominic P Francese; Elizabeth Y Wang; Anna Falanga; Claire McLintock; Beverley J Hunt; Alex C Spyropoulos; Geoffrey D Barnes; John W Eikelboom; Ido Weinberg; Sam Schulman; Marc Carrier; Gregory Piazza; Joshua A Beckman; P Gabriel Steg; Gregg W Stone; Stephan Rosenkranz; Samuel Z Goldhaber; Sahil A Parikh; Manuel Monreal; Harlan M Krumholz; Stavros V Konstantinides; Jeffrey I Weitz; Gregory Y H Lip Journal: J Am Coll Cardiol Date: 2020-04-17 Impact factor: 24.094
Authors: Paul Marc Biever; Dawid Leander Staudacher; Jonas Degott; Corinna Nadine Lang; Christoph Bode; Tobias Wengenmayer Journal: Clin Res Cardiol Date: 2019-07-12 Impact factor: 5.460
Authors: Thomas Scherz; Thomas M Hofbauer; Anna S Ondracek; Daniel Simon; Fritz Sterz; Christoph Testori; Irene M Lang; Andreas Mangold Journal: Front Cardiovasc Med Date: 2021-07-06