Thread by @drdangayach

@CritCareReviews Ready 🙌 @emcrit #neuroEmcrit #neurocriticalcare @PulmCrit @adamdavidthomas

@CritCareReviews @emcrit @PulmCrit @adamdavidthomas @nielsen_niklas presenting results @ttm2trial now join the livestream #SCCMSoME cochranelibrary.com/cdsr/doi/10.10… Low numbers, lack of certainty hence need for TTM nejm.org/doi/full/10.10… #CHESTTrainees @neurocritical

@CritCareReviews @emcrit @PulmCrit @adamdavidthomas @nielsen_niklas @ttm2trial @neurocritical Variability in evidence, lack of definitive answer for TTM/clinical equipoise @ttm2trial @WICSBottomLine power calculation based on ARR of 7.5, n=1900. Inclusion: Adult, comatose, cardiac arrest-cardiac/unknown; stable ROSC, no ECMO, not asystole, max time from arrest 180 mins

@CritCareReviews @emcrit @PulmCrit @adamdavidthomas @nielsen_niklas @ttm2trial @neurocritical 6 month Outcomes: All cause mortality, functional outcome (mRS not CPC)

@CritCareReviews @emcrit @PulmCrit @adamdavidthomas @nielsen_niklas @ttm2trial @neurocritical @WICSBottomLine Blinding of all aspects @ttm2trial except Rx (obviously difficult to blind)-prognosis, participants, outcome assessors, authors, steering group, manuscript written in duplicate-interesting!!

@CritCareReviews @emcrit @PulmCrit @adamdavidthomas @nielsen_niklas @ttm2trial @neurocritical @WICSBottomLine What’s the definition of fever @ttm2 37.7 or higher...@IDSAInfo what say. Nice global representation. Finished recruitment in Jan 2020...

@CritCareReviews @emcrit @PulmCrit @adamdavidthomas @nielsen_niklas @ttm2trial @neurocritical @WICSBottomLine 56 % of all pts screened (2455/4355) were not randomized. Common reasons for not randomizing. Survival analysis included 1850/1900. Hypothermia 930, Normothermia 931

@CritCareReviews @emcrit @PulmCrit @adamdavidthomas @nielsen_niklas @ttm2trial @neurocritical @WICSBottomLine In both groups, about 80 per cent had a shockable rhythm, a third in shock, ROSC about 25 mins, 40% had STEMIs. Target temp achieved in about 3-4 hours in both groups. Interestingly, both groups had a similar incidence of pneumonia as well as bleeding AES

@CritCareReviews @emcrit @PulmCrit @adamdavidthomas @nielsen_niklas @ttm2trial @neurocritical @WICSBottomLine No difference in 6 month all cause mortality!! Fever prevention is better than hypothermia 🥶deep dive into subgroups and neurological outcomes @katereillymd @AlexReynoldsMD @MountSinaiNCC @JohnLiangMD @senelson13 @STsetsou

@CritCareReviews @emcrit @PulmCrit @adamdavidthomas @nielsen_niklas @ttm2trial @neurocritical @WICSBottomLine @katereillymd @AlexReynoldsMD @MountSinaiNCC @JohnLiangMD @senelson13 @STsetsou Secondary outcomes in line with COSCA @COMETinitiative Good outcome mRS 0-3 (similar to ICH trials but mRS 0-2 good outcome for ischemic stroke trials). 94 per cent (1747/1861) and 72 per cent face to face!! great follow-up rate @WesElyMD @DrDaleNeedham

@CritCareReviews @emcrit @PulmCrit @adamdavidthomas @nielsen_niklas @ttm2trial @neurocritical @WICSBottomLine @katereillymd @AlexReynoldsMD @MountSinaiNCC @JohnLiangMD @senelson13 @STsetsou @COMETinitiative @WesElyMD @DrDaleNeedham Wow! Shift analysis almost identical...Consistent results in all prespecified subgroups. Where is the silver lining?

@CritCareReviews @emcrit @PulmCrit @adamdavidthomas @nielsen_niklas @ttm2trial @neurocritical @WICSBottomLine @katereillymd @AlexReynoldsMD @MountSinaiNCC @JohnLiangMD @senelson13 @STsetsou @COMETinitiative @WesElyMD @DrDaleNeedham And self report of HRQOL (EQ VAS)...no difference

@CritCareReviews @emcrit @PulmCrit @adamdavidthomas @nielsen_niklas @ttm2trial @neurocritical @WICSBottomLine @katereillymd @AlexReynoldsMD @MountSinaiNCC @JohnLiangMD @senelson13 @STsetsou @COMETinitiative @WesElyMD @DrDaleNeedham #TTM2 on to the editorial comments from Stephen Bernard