Effects of endovascular and surface cooling on resuscitation in patients with cardiac arrest and a comparison of effectiveness, stability, and safety: a systematic review and meta-analysis.
Topic: Hyperthermia

This study conducted a meta-analysis to assess the effectiveness, stability, and safety of mild therapeutic hypothermia (TH) induced by endovascular cooling (EC) and surface cooling (SC) and its effect on ICU, survival rate, and neurological function integrity in adult CA patients.

PICO
Population: Adult patients with cardiac arrest
Intervention: Mild therapeutic hypothermia induced by endovascular cooling (EC) and surface cooling (SC)
Comparison: Comparison of effectiveness, stability, and safety between EC and SC
Outcomes: ICU stay, survival rate, neurological function integrity

Included studies:
title: A comparison of intravascular and surface cooling techniques in comatose cardiac arrest survivors.
abstract: Mild therapeutic hypothermia after out-of-hospital cardiac arrest is usually achieved either by surface cooling or by core cooling via the patient's bloodstream. We compared modern core (Coolgard) and surface (Arctic Sun) cooling devices with a zero hypothesis of equal cooling, complications, and neurologic outcomes.
title: Invasive versus non-invasive cooling after in- and out-of-hospital cardiac arrest: a randomized trial.
abstract: Mild induced hypothermia (MIH) is indicated for comatose survivors of sudden cardiac arrest (SCA) to improve clinical outcome. In this study, we compared the efficacy of two different cooling devices for temperature management in SCA survivors.
title: Comparison of intravascular and conventional hypothermia after cardiac arrest.
abstract: Therapeutic hypothermia is currently the best-documented method of improving neurological outcomes in patients after cardiac arrest and successful resuscitation. There is a variety of methods for lowering body temperature. However, there are no data showing that any specific method of cooling improves the results or increases survival. A simple method involving surface cooling and ice-cold intravenous fluids, as well as more technologically advanced methods, are used in clinical practice. One of the more advanced methods is intravascular hypothermia, during which cooling is carried out with the use of a special catheter located in the central vein.
title: Efficacy of different cooling technologies for therapeutic temperature management: A prospective intervention study.
abstract: Mild therapeutic hypothermia (32-36 °C) is associated with improved outcomes in patients with brain injury after cardiac arrest (CA). Various devices are available to induce and maintain hypothermia, but few studies have compared the performance of these devices. We performed a prospective study to compare four frequently used cooling systems in inducing and maintaining hypothermia followed by controlled rewarming.
title: Efficacy and safety of endovascular cooling after cardiac arrest: cohort study and Bayesian approach.
abstract: Recently 2 randomized trials in comatose survivors of cardiac arrest documented that therapeutic hypothermia improved neurological recovery. The narrow inclusion criteria resulted in an international recommendation to cool only a restricted group of primary cardiac arrest survivors. In this retrospective cohort study we investigated the efficacy and safety of endovascular cooling in unselected survivors of cardiac arrest.
title: Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest.
abstract: Cardiac arrest with widespread cerebral ischemia frequently leads to severe neurologic impairment. We studied whether mild systemic hypothermia increases the rate of neurologic recovery after resuscitation from cardiac arrest due to ventricular fibrillation.
title: Influence of neonatally-administered monosodium glutamate on the neuroendocrine regulation of prolactin cell activity in adult Syrian hamsters.
abstract: The effects of MSG on PRL cell activity in hamsters was assessed by injecting either MSG (8 mg/g body weight) or saline into male and female hamsters on day 8 of the neonatal period. One-hundred and three days later, the anterior pituitaries were removed for the analysis of PRL synthesis and storage. Serum PRL levels were also determined by radioimmunoassay as an index of in vivo PRL secretion. Blood levels of PRL were decreased by 74% in female and 88% in male hamsters treated with MSG as compared with vehicle controls. In females, glutamate induced a drop in PRL storage (90%) and synthesis (82%) while in male animals glutamate caused a non-significant decrease in PRL storage (48%) and synthesis (31%) as compared with controls. These results indicate that MSG-induced arcuate nucleus lesions inhibit PRL cell activity in the hamster.
title: Therapeutic hypothermia after cardiac arrest: a retrospective comparison of surface and endovascular cooling techniques.
abstract: Therapeutic hypothermia (32-34 degrees C) is recommended for comatose survivors of cardiac arrest; however, the optimal technique for cooling is unknown. We aimed to compare therapeutic hypothermia using either surface or endovascular techniques in terms of efficacy, complications and outcome.
title: Endovascular Versus External Targeted Temperature Management for Patients With Out-of-Hospital Cardiac Arrest: A Randomized, Controlled Study.
abstract: Targeted temperature management is recommended after out-of-hospital cardiac arrest. Whether advanced internal cooling is superior to basic external cooling remains unknown. The aim of this multicenter, controlled trial was to evaluate the benefit of endovascular versus basic surface cooling.
title: Mild hypothermia induced by a helmet device: a clinical feasibility study.
abstract: To test the feasibility and the speed of a helmet device to achieve the target temperature of 34 degrees C in unconscious after out of hospital cardiac arrest (CA).
title: Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia.
abstract: Cardiac arrest outside the hospital is common and has a poor outcome. Studies in laboratory animals suggest that hypothermia induced shortly after the restoration of spontaneous circulation may improve neurologic outcome, but there have been no conclusive studies in humans. In a randomized, controlled trial, we compared the effects of moderate hypothermia and normothermia in patients who remained unconscious after resuscitation from out-of-hospital cardiac arrest.
title: A prospective, multicenter pilot study to evaluate the feasibility and safety of using the CoolGard System and Icy catheter following cardiac arrest.
abstract: Cardiac arrest causes devastating neurological morbidity and mortality. Mild/moderate hypothermia is neuroprotective after global cerebral ischemia. More rapid controlled attainment of the target temperature may increase efficacy.
title: Clinical application of mild therapeutic hypothermia after cardiac arrest.
abstract: Postresuscitative mild hypothermia lowers mortality, reduces neurologic impairment after cardiac arrest, and is recommended by the International Liaison Committee on Resuscitation. The European Resuscitation Council Hypothermia After Cardiac Arrest Registry was founded to monitor implementation of therapeutic hypothermia, to observe feasibility of adherence to the guidelines, and to document the effects of hypothermic treatment in terms of complications and outcome.
title: Randomized controlled trial of internal and external targeted temperature management methods in post- cardiac arrest patients.
abstract: Targeted temperature management post-cardiac arrest is currently implemented using various methods, broadly categorized as internal and external. This study aimed to evaluate survival-to-hospital discharge and neurological outcomes (Glasgow-Pittsburgh Score) of post-cardiac arrest patients undergoing internal cooling verses external cooling.