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Roshini Claire Anthony, 6 days ago

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TTM with internal cooling provides tighter temperature control, better survival outcomes

16 Aug 2017

In targeted temperature management (TTM) postcardiac arrest, tighter temperature control is achieved with internal than external cooling, a study has shown. Moreover, internal cooling potentially results in better survival-to-hospital discharge outcomes and reduces cardiac arrhythmia complications in carefully selected patients as compared with normothermia.

The study included 45 postresuscitation cardiac arrest patients and 42 matched controls. Patients were randomly assigned to the internal cooling arm (n=23) or the external cooling arm (n=22). Descriptive statistics and frequencies, as well as univariate logistic regression, were used in the analyses.

Survival, neurological outcomes and complications were not found to be significantly different between the internal and external cooling arms. However, the internal cooling arm had a lower risk of developing overcooling (p=0.01) and rebound hyperthermia (p=0.02).

Additionally, compared with normothermia control, internal cooling was associated with higher survival (odds ratio [OR], 3.36; 95 percent CI, 1.130 to 10.412) and lower risk of developing cardiac arrhythmias (OR, 0.18; 0.04 to 0.63).

Subgroup analysis demonstrated better survival with internal cooling vs normothermia among patients with cardiac cause of arrest (OR, 4.29; 1.26 to 15.80) and sustained return of spontaneous circulation (OR, 5.50; 1.64 to 20.39).

In unconscious patients admitted to the intensive care unit after cardiac arrest, short- and long-term outcomes are characterized by prognostic uncertainty and a high risk of death and neurologic deficit. TTM has been used to improve the chance of survival and neurologic recovery, in addition with urgent coronary angiography and percutaneous coronary intervention when appropriate. Current recommendations based on two largest randomized clinical trials on TTM cite that the patient’s temperature should be kept at a target of 32 to 36°C for at least 24 hours. [Circulation 2015;132:S465-S482; N Engl J Med 2013;369:2197-2206; 2002;346:549-556]

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Most Read Articles
Roshini Claire Anthony, 6 days ago

Treatment failure in osteoporosis remains a problem, even among patients who are treatment-adherent, according to a presentation at the recent meeting of the Asian Federation of Osteoporosis Societies (AFOS 2017), held in Kuala Lumpur, Malaysia. 

Elvira Manzano, 5 days ago
Bisphosphonates have proven antifracture efficacy and remain to be the cornerstone of osteoporosis treatment. However, a drug holiday is of particular importance with bisphosphonates due to some signals with long-term use of the drug, including rare incidence of atypical femoral fracture (AFF) and osteonecrosis of the jaw (ONJ), says a leading endocrinologist at AFOS 2017.
2 days ago
Breast cancer patients have notably different microbiomes in the local breast tissue and urinary tract, a recent study reveals. Particularly, species in the Methylobacterium genus are reduced in the local breast tissue while the urinary tract is enriched in gram-positive bacteria.
Pearl Toh, 13 Oct 2017
Women with higher plasma tryptophan concentrations were less likely to have poor sleep quality during pregnancy, especially among those with anxiety symptoms, according to the GUSTO* study.