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Ther Hypothermia Temp Manag. 2019 Oct 29. doi: 10.1089/ther.2019.0027. [Epub ahead of print]

Sinus Bradycardia During Targeted Temperature Management: A Systematic Review and Meta-Analysis.

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Postgraduate Study Program (MSc) "Cardiopulmonary Resuscitation," Medical School, National and Kapodistrian University of Athens, Athens, Greece.
4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece.
Hepato-gastroenterology Unit, 2nd Department of Internal Medicine-Propaedeutic Research Institute and Diabetes Center, National and Kapodistrian University of Athens, Athens, Greece.
Faculty of Medicine, Department of Anesthesiology, University of Thessaly, Larisa, Greece.
Department of Biopathology, Medical School, Aretaieio Hospital, National and Kapodistrian University of Athens, Athens, Greece.
Department of Physiology and Pathophysiology, School of Medicine, European University Cyprus, Nicosia, Cyprus.


The beneficial effect of sinus bradycardia during targeted temperature management (TTM) in cardiac arrest patients remains doubtful. We aimed to investigate the impact of sinus bradycardia on survival and neurological outcome. MEDLINE (PubMed), Cochrane, Google Scholar, and databases were searched for studies reporting on comatose postcardiac arrest patients presenting sinus bradycardia during TTM. Outcomes were the 180-day survival and final neurologic function assessed by the Cerebral Performance Category scale. The effect size on study outcomes is presented as odds ratio (OR) with 95% confidence interval (CI). Two studies with 681 patients were included. Compared to no-sinus bradycardia group, in patients with sinus bradycardia below 50 bpm, a significant effect of sinus bradycardia on reduction of 180-day mortality was reported (OR = 0.42; 95% CI: 0.29-0.59). No heterogeneity was detected. Sinus bradycardia below 50 bpm during TTM may be protective and should be considered in comatose postcardiac arrest patients.


bradycardia; mortality; neurological outcome; targeted temperature management


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