Therapeutic Hypothermia is Associated With A Decrease in All-Cause Mortality in Cardiac Arrest Due To Shockable Rhythm

BACKGROUND: The benefits of therapeutic hypothermia (TH) in comatose patients post cardiac arrest remain uncertain. While some studies have shown benefit, others have shown equivocal results. We pooled data from randomized controlled trials to better study the outcomes of TH. METHODS: Electronic research databases were queried up till September 21, 2021. Randomized controlled trials comparing TH (32°C to 34°C) with control (normothermia or temperature ≥ 36°C) in comatose post cardiac arrest patients were included. RESULTS: The study included ten RCT\u27s with 3988 subjects (1999 in the therapeutic hypothermia arm, and 1989 in the control arm). There was no difference in all-cause mortality between TH and control (OR 0.83; 95% confidence interval [CI]: 0.66 to 1.05; p = 0.08; I2 = 41%). There was no difference in the odds of poor neurological outcomes (OR 0.78; 95% CI: 0.61 to 1.01; p= 0.07; I2 = 43%). Subgroup analysis showed a decrease in all-cause mortality and poor neurological outcomes with therapeutic hypothermia in shockable rhythms (OR 0.55; 95% CI: 0.37 to 0.80; p = 1.00; I2 = 0% and OR 0.48; 95% CI 0.32 to 0.72; p = 0.92; I2 = 0% respectively). CONCLUSION: Therapeutic hypothermia may be beneficial in reducing mortality and poor neurological outcomes in comatose post-cardiac arrest patients with shockable rhythms

Trends and outcomes of infective endocarditis in cirrhosis: a propensity-matched national study.

BACKGROUND: Cirrhosis is the most common cause of liver-related death and bacterial infection is a common comorbidity in cirrhosis. We aimed to study the trends and outcomes of infective endocarditis in cirrhosis. METHODS: A propensity-matched analysis of the National Inpatient Sample database was performed to assess outcomes of infective endocarditis in adult patients (\u3e18 years) from 2004-2013 with and without cirrhosis. Various outcomes were assessed for outcomes of infective endocarditis in cirrhosis. Multivariate regression analysis was performed for predictors of mortality in infective endocarditis. RESULTS: There has been no significant change in incidence (3.3-3.6%, P = 0.27) and overall mortality (6.3-8.6%, P = 0.42) of infective endocarditis in cirrhosis. After propensity matching, patients with cirrhosis had significantly higher in-hospital mortality (15 vs. 10.6%, P \u3c 0.001) and acute kidney injury (AKI) (31.8 vs. 28.5%, P \u3c 0.001) as compared to no cirrhosis. Microbiological analysis revealed significantly higher rates of streptococci (35.3 vs. 31.9%, P \u3c 0.001) and fungal infective endocarditis (0.03 vs. 0%, P \u3c 0.001) and lower incidence of Gram-negative infective endocarditis (3.9 vs. 6.3%, P \u3c 0.001) in cirrhosis. Cirrhosis patients had significantly less surgical intervention (10.2 vs. 30.3%, P \u3c 0.001) along with overall total cost and length of stay as compared to no cirrhosis. On multivariate analysis, advanced age, AKI, shock and mechanical ventilation were positive predictors of mortality in infective endocarditis patients with cirrhosis patients. CONCLUSIONS: Cirrhosis is an independent predictor of mortality in infective endocarditis with worse outcomes and less surgical intervention. Gram-negative infective endocarditis is lower in cirrhosis, whereas streptococci and fungal infective endocarditis are higher than noncirrhotic patients

Therapeutic Hypothermia is Associated With A Decrease in All-Cause Mortality in Cardiac Arrest Due To Shockable Rhythm.

BACKGROUND: The benefits of therapeutic hypothermia (TH) in comatose patients post cardiac arrest remain uncertain. While some studies have shown benefit, others have shown equivocal results. We pooled data from randomized controlled trials to better study the outcomes of TH. METHODS: Electronic research databases were queried up till September 21, 2021. Randomized controlled trials comparing TH (32°C to 34°C) with control (normothermia or temperature ≥ 36°C) in comatose post cardiac arrest patients were included. RESULTS: The study included ten RCT\u27s with 3988 subjects (1999 in the therapeutic hypothermia arm, and 1989 in the control arm). There was no difference in all-cause mortality between TH and control (OR 0.83; 95% confidence interval [CI]: 0.66 to 1.05; p = 0.08; I2 = 41%). There was no difference in the odds of poor neurological outcomes (OR 0.78; 95% CI: 0.61 to 1.01; p= 0.07; I2 = 43%). Subgroup analysis showed a decrease in all-cause mortality and poor neurological outcomes with therapeutic hypothermia in shockable rhythms (OR 0.55; 95% CI: 0.37 to 0.80; p = 1.00; I2 = 0% and OR 0.48; 95% CI 0.32 to 0.72; p = 0.92; I2 = 0% respectively). CONCLUSION: Therapeutic hypothermia may be beneficial in reducing mortality and poor neurological outcomes in comatose post-cardiac arrest patients with shockable rhythms