Effect of post-rewarming fever after targeted temperature management in cardiac arrest patients: a systematic review and meta-analysis

doi:10.5847/wjem.j.1920-8642.2023.056

Abstract

Abstract:

BACKGROUND: Targeted temperature management (TTM), as a therapeutic temperature control strategy for cardiac arrest (CA), is recommended by guidelines. However, the relationship between post-rewarming fever (PRF) and the prognosis of CA patients is unclear. Therefore, we aim to summarize the studies regarding the influence of PRF on patients with CA.

METHODS: EMBASE, PubMed, and Cochrane Central databases were searched from inception to March 13, 2022. Randomized clinical trials (RCTs) and cohort studies on PRF in CA patients were included. According to the heterogeneity, the meta-analysis was performed using a random effects model or fixed effects model to calculate the pooled odds ratios (ORs) and corresponding 95% confidence intervals (CIs). The outcome data were unfavorable neurological outcome and mortality.

RESULTS: The meta-analysis included 11 observational studies involving 3,246 patients. The results of the meta-analysis show that PRF (body temperature >38.0 °C) has no effect on the neurological outcome of CA patients (OR 0.71, 95% CI 0.43-1.17, I² 82%) and has a significant relationship with lower mortality (OR 0.63; 95% CI 0.49-0.80, I² 39%). However, PRF with a stricter definition (body temperature >38.5 °C ) was associated with worse neurological outcome (OR 1.44, 95% CI 1.08-1.92, I² 45%) and higher mortality (OR 1.71, 95% CI 1.25-2.35, I² 47%).

CONCLUSION: This study suggests that PRF >38.0 °C may not affect the neurological outcome and have a lower mortality in CA patients who completed TTM. However, PRF >38.5 °C is a potential prognostic factor for worse outcomes in CA patients.

Key words: Cardiac arrest, Target temperature management, Post-rewarming fever, Rebound hyperthermia

Guang-qi Guo, Yan-nan Ma, Shuang Xu, Hong-rong Zhang, Peng Sun. Effect of post-rewarming fever after targeted temperature management in cardiac arrest patients: a systematic review and meta-analysis[J]. World Journal of Emergency Medicine, 2023, 14(3): 217-223.

Figures/Tables 3

Table 1.

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Author/year	Country	TTM strategies	Rate of rewarming	Definition of normothermia	Consciousness	Timing of onset of fever	Definition of PRF	Type of CA	Outcome assessment timing	Mortality	Patients (n)	PRF (n)/ normothermia (n)
Holm 2021^[25]	Europe	32-36 ℃ for 24 h or 48 h	0.5 ℃/h	37.0 ℃	Coma	Within 72 h after rewarming	38.5 ℃	OHCA	CPC at 6 months	In-hospital	338	103/235
Lee 2020^[20]	Korea	32-36 ℃ for 24 h	0.2-0.5 ℃/h	NA	All*	Within 72 h after rewarming	38.0 ℃	OHCA	CPC at 6 months	NA	1,031	389/642
Makker 2017^[21]	America	32-34 ℃ for 24 h	0.25 ℃/h	37.0 ℃	All	Within 24 h after rewarming	38.0 ℃	OHCA	CPC in-hospital	In-hospital	97	54/43
Grossestreuer 2017^[17]	America	<34 ℃ for unknown hours	NA	36.5 ℃	All	Within 72 h after rewarming	38.0 ℃	Both**	CPC at discharge	Discharge	465	179/286
Lee 2015^[19]	Korea	32-34 ℃ for 24 h	0.2-0.5 ℃/h	36.5 ℃	All	Within 48 h after rewarming	38.0 ℃	Both	CPC at discharge	In-hospital	277	81/196
Nobile 2015^[22]	Belgium	32-34 ℃ for 24 h	0.5 ℃/h	37.0 ℃	Coma	Within 24 h after rewarming	38.5 ℃	Both	CPC at 3 months	NA	229	41/188
Cocchi 2014^[16]	America	32-34 ℃ for unknown hours	NA	NA	All	Within 24 h after rewarming	38.0 ℃	OHCA	CPC in-hospital	In-hospital	54	28/26
Winters 2013^[24]	America	32-34 ℃ for 24 h	NA	NA	All	First 24 h of the re-warming process	38.5 ℃	OHCA	mRS at discharge	In-hospital	141	42/99
Leary 2013^[18]	America	32-34 ℃ for 24 h	NA	37.0 ℃	All	Within 24 h after rewarming	38.0 ℃	Both	CPC at discharge	discharge	167	69/98
Bro-Jeppesen 2013^[15]	Denmark	32-34 ℃ for 24 h	0.5 ℃/h	36.5 ℃	Coma	Within 36 h after rewarming	38.5 ℃	OHCA	CPC at discharge	30 days	270	136/134
Benz-Woerner 2012^[14]	Switzerland	32-34 ℃ for 24 h	NA	37.0 ℃	Coma	NA	38.0 ℃	Both	NA	In-hospital	177	135/42