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Targeted Temperature Management at 33°C Versus Controlled Normothermia for In-hospital Cardiac Arrest
Sponsor: Nantes University Hospital
Summary
The IH-TTM trial is designed to determine whether survival with a favorable neurological outcome is improved by induced hypothermia at 33°C in comatose critically ill patients admitted after resuscitated in-hospital cardiac arrest (IHCA). Recent evidence suggests that targeted temperature management (TTM) at 33°C may provide no survival benefits compared to controlled normothermia in unselected patients with out-of-hospital cardiac arrest (OHCA). However, this evidence is relevant only to OHCA of presumed cardiac origin, chiefly witnessed and immediately followed by resuscitation efforts. Only scant data are available for cardiac arrest (CA) of other origins and for IHCA. In a randomized clinical trial of patients with CA in an initial non-shockable rhythm, the subgroup with IHCA had significantly better outcomes when treated with TTM at 33°C versus controlled normothermia; nevertheless, the sample size was limited. Another randomized controlled trial done specifically in patients with IHCA failed to show benefits of TTM at 33°C compared to controlled normothermia but was underpowered. Thus, whether therapeutic hypothermia is indicated after IHCA remains unclear. IH-TTM will be the largest trial assessing TTM after IHCA.
Key Details
Gender
All
Age Range
18 Years - Any
Study Type
INTERVENTIONAL
Enrollment
788
Start Date
2026-05-01
Completion Date
2029-05-01
Last Updated
2026-01-28
Healthy Volunteers
No
Conditions
Interventions
Induced hypothermia at 33°C
Cooling and maintenance phase : The aim is to achieve the target temperature of 33±0.5°C within 60 minutes after randomization. The target temperature of 33±0.5°C and device setting of 33°C will be maintained until 28 hours after randomization. \- Rewarming: Normothermia will be restored by gradual rewarming at a rate of 0.2°C/h. \- After rewarming: After 40 hours, in those participants who are still comatose or sedated, normothermia (36.5-37.7°C) will be maintained until 72 hours after randomization, and active warming will be avoided.
Control normothermia
Participants whose initial temperature is below 33°C may be actively rewarmed to 36.5°-37.7°C, at which point active rewarming will be stopped and passive rewarming performed according to the latest guidelines. Participants whose initial temperature is above 33°C will not be actively rewarmed to normothermia. The goal will be to maintain temperature no higher than 37.8°C. After 40 hours, in those participants who are still comatose or sedated, normothermia (36.5-37.7°C) will be maintained until 72 hours after randomization, and active warming will be avoided.
Locations (32)
Hôpital Erasme
Brussels, Belgium
CHU Charleroi
Charleroi, Belgium
Hôpital Universitaire de Gand
Ghent, Belgium
Hôpital Universitaire de Bruxelles
Jette, Belgium
Clinique Saint-PIerre
Ottignies, Belgium
CH d'Angoulême
Angoulême, France
CH Dubois Brive
Brive-la-Gaillarde, France
CHU de Caen
Caen, France
Hôpital Simone Veil
Cannes, France
CH Public du Cotentin
Cherbourg, France
CHU Clermont-Ferrand
Clermont-Ferrand, France
CHU Bocage
Dijon, France
CHD Vendée
La Roche-sur-Yon, France
Hôpital André Mignot
Le Chesnay, France
CHRU- Hôpital Roger Salengro
Lille, France
CHU Dupuytren
Limoges, France
Hôpital Edouard Herriot
Lyon, France
APHM - Hôpital Nord
Marseille, France
Hôpital Privé Jacques Cartier
Massy, France
CHU de Nantes
Nantes, France
Hôpital de l'Archet
Nice, France
CHR d'Orléans
Orléans, France
APHP-Hôpital Saint-Antoine
Paris, France
APHP- Hôpital Cochin
Paris, France
APHP - Hôpital Ambroise Paré
Paris, France
CH de Roanne
Roanne, France
CH de Rodez
Rodez, France
CHRU de Strasbourg
Strasbourg, France
Hôpital Sainte-Musse
Toulon, France
CHRU de Tours
Tours, France
CH Brocéliande Atlantique
Vannes, France
CHU Les Abymes
Pointe-à-Pitre, La Guadeloupe, Guadeloupe