Editorial for the paper of Dr. Hans Kirkegaard et al. JAMA 2017;318:341-50

Mayuki Aibiki

Abstract

The International Liaison Committee on Resuscitation (ILCOR) published the Consensus of Science for Treatments and Recommendations (CoSTR) 2015, a body of systematic reviews on resuscitation science. According to the CoSTR, Guidelines 2015 have been developed in several countries, in which targeted temperature management (TTM) at 33 to 36 ℃ has been recommended in unconscious victims after out-of-hospital cardiac arrest (OHCA) at least for 24 hours, but the optimal duration for TTM was unclear. Dr. Hans Kirkegaard et al. has tested a hypothesis in an international multicenter randomized control trial (RCT) whether TTM at 33 ℃ for 48 hours could bring more favorable outcomes as compared to that for 24 hours in patients at six months after OHCA from a presumed cardiac origin, in which TTM for 48 hours did not show any benefits on neurologic outcomes over 24 hours (1). This result indicates that TTM of 33 ℃ for 24 hours could be a choice of the treatments for comatose survivors from OHCA. Regarding the ‘dosing’ of TTM duration in this study, there has already been a thoughtful and excellent editorial written by Dr. Clifton Callaway, Pittsburg Medical Center, in the same issue of JAMA. So, I would like to review the current study from a different point of view as follows.