Detailed statistical analysis plan for the target temperature management after out-of-hospital cardiac arrest trial

Niklas Nielsen; Per Winkel; Tobias Cronberg; David Erlinge; Hans Friberg; Yvan Gasche; Christian Hassager; Janneke Horn; Jan Hovdenes; Jesper Kjaergaard; Michael Kuiper; Tommaso Pellis; Pascal Stammet; Michael Wanscher; Matt P Wise; Anders Aneman; Jørn Wetterslev

doi:10.1186/1745-6215-14-300

Detailed statistical analysis plan for the target temperature management after out-of-hospital cardiac arrest trial

Niklas Nielsen, Per Winkel, Tobias Cronberg, David Erlinge, Hans Friberg, Yvan Gasche, Christian Hassager, Janneke Horn, Jan Hovdenes, Jesper Kjaergaard, Michael Kuiper, Tommaso Pellis, Pascal Stammet, Michael Wanscher, Matt P Wise, Anders Aneman, Jørn Wetterslev

Department of Clinical Medicine

22 Citations (Scopus)

Abstract

Background: Animal experimental studies and previous randomized trials suggest an improvement in mortality and neurological function with temperature regulation to hypothermia after cardiac arrest. According to a systematic review, previous trials were small, had a risk of bias, evaluated select populations, and did not treat hyperthermia in the control groups. The optimal target temperature management (TTM) strategy is not known. To prevent outcome reporting bias, selective reporting and data-driven results, we present the a priori defined detailed statistical analysis plan as an update to the previously published outline of the design and rationale for the TTM trial.Methods: The TTM trial is an investigator-initiated, multicenter, international, randomized, parallel-group, and assessor-blinded clinical trial of temperature management in 950 adult unconscious patients resuscitated after out-of-hospital cardiac arrest of a presumed cardiac cause. The patients are randomized to a TTM of either 33°C or 36°C after return of spontaneous circulation. The primary outcome is all-cause mortality at maximal follow-up (until end of the trial and a minimum of 180 days). The main secondary outcomes are the composite outcome of all-cause mortality and poor neurological function (Cerebral Performance Category (CPC) 3 and 4, and modified Rankin Scale (mRS) 4 and 5) at hospital discharge and at 180 days; and assessment of safety and harm: bleeding, infections, electrolyte and metabolic disorders, seizures, cardiac arrhythmia, and renal replacement therapy.Conclusion: The TTM trial investigates potential benefit and harm of two target temperature strategies, both avoiding hyperthermia in a large proportion of the out-of-hospital cardiac arrest population.

Original language	English
Article number	300
Journal	Trials
Volume	14
Issue number	September
Pages (from-to)	1-8
Number of pages	8
ISSN	1745-6215
DOIs	https://doi.org/10.1186/1745-6215-14-300
Publication status	Published - 17 Sept 2013

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Nielsen, N., Winkel, P., Cronberg, T., Erlinge, D., Friberg, H., Gasche, Y., Hassager, C., Horn, J., Hovdenes, J., Kjaergaard, J., Kuiper, M., Pellis, T., Stammet, P., Wanscher, M., Wise, M. P., Aneman, A., & Wetterslev, J. (2013). Detailed statistical analysis plan for the target temperature management after out-of-hospital cardiac arrest trial. Trials, 14(September), 1-8. [300]. https://doi.org/10.1186/1745-6215-14-300

Nielsen, N, Winkel, P, Cronberg, T, Erlinge, D, Friberg, H, Gasche, Y, Hassager, C, Horn, J, Hovdenes, J, Kjaergaard, J, Kuiper, M, Pellis, T, Stammet, P, Wanscher, M, Wise, MP, Aneman, A & Wetterslev, J 2013, 'Detailed statistical analysis plan for the target temperature management after out-of-hospital cardiac arrest trial', Trials, vol. 14, no. September, 300, pp. 1-8. https://doi.org/10.1186/1745-6215-14-300

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title = "Detailed statistical analysis plan for the target temperature management after out-of-hospital cardiac arrest trial",

abstract = "Background: Animal experimental studies and previous randomized trials suggest an improvement in mortality and neurological function with temperature regulation to hypothermia after cardiac arrest. According to a systematic review, previous trials were small, had a risk of bias, evaluated select populations, and did not treat hyperthermia in the control groups. The optimal target temperature management (TTM) strategy is not known. To prevent outcome reporting bias, selective reporting and data-driven results, we present the a priori defined detailed statistical analysis plan as an update to the previously published outline of the design and rationale for the TTM trial.Methods: The TTM trial is an investigator-initiated, multicenter, international, randomized, parallel-group, and assessor-blinded clinical trial of temperature management in 950 adult unconscious patients resuscitated after out-of-hospital cardiac arrest of a presumed cardiac cause. The patients are randomized to a TTM of either 33°C or 36°C after return of spontaneous circulation. The primary outcome is all-cause mortality at maximal follow-up (until end of the trial and a minimum of 180 days). The main secondary outcomes are the composite outcome of all-cause mortality and poor neurological function (Cerebral Performance Category (CPC) 3 and 4, and modified Rankin Scale (mRS) 4 and 5) at hospital discharge and at 180 days; and assessment of safety and harm: bleeding, infections, electrolyte and metabolic disorders, seizures, cardiac arrhythmia, and renal replacement therapy.Conclusion: The TTM trial investigates potential benefit and harm of two target temperature strategies, both avoiding hyperthermia in a large proportion of the out-of-hospital cardiac arrest population.",

author = "Niklas Nielsen and Per Winkel and Tobias Cronberg and David Erlinge and Hans Friberg and Yvan Gasche and Christian Hassager and Janneke Horn and Jan Hovdenes and Jesper Kjaergaard and Michael Kuiper and Tommaso Pellis and Pascal Stammet and Michael Wanscher and Wise, {Matt P} and Anders Aneman and J{\o}rn Wetterslev",

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doi = "10.1186/1745-6215-14-300",

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T1 - Detailed statistical analysis plan for the target temperature management after out-of-hospital cardiac arrest trial

AU - Nielsen, Niklas

AU - Winkel, Per

AU - Cronberg, Tobias

AU - Erlinge, David

AU - Friberg, Hans

AU - Gasche, Yvan

AU - Hassager, Christian

AU - Horn, Janneke

AU - Hovdenes, Jan

AU - Kjaergaard, Jesper

AU - Kuiper, Michael

AU - Pellis, Tommaso

AU - Stammet, Pascal

AU - Wanscher, Michael

AU - Wise, Matt P

AU - Aneman, Anders

AU - Wetterslev, Jørn

PY - 2013/9/17

Y1 - 2013/9/17

N2 - Background: Animal experimental studies and previous randomized trials suggest an improvement in mortality and neurological function with temperature regulation to hypothermia after cardiac arrest. According to a systematic review, previous trials were small, had a risk of bias, evaluated select populations, and did not treat hyperthermia in the control groups. The optimal target temperature management (TTM) strategy is not known. To prevent outcome reporting bias, selective reporting and data-driven results, we present the a priori defined detailed statistical analysis plan as an update to the previously published outline of the design and rationale for the TTM trial.Methods: The TTM trial is an investigator-initiated, multicenter, international, randomized, parallel-group, and assessor-blinded clinical trial of temperature management in 950 adult unconscious patients resuscitated after out-of-hospital cardiac arrest of a presumed cardiac cause. The patients are randomized to a TTM of either 33°C or 36°C after return of spontaneous circulation. The primary outcome is all-cause mortality at maximal follow-up (until end of the trial and a minimum of 180 days). The main secondary outcomes are the composite outcome of all-cause mortality and poor neurological function (Cerebral Performance Category (CPC) 3 and 4, and modified Rankin Scale (mRS) 4 and 5) at hospital discharge and at 180 days; and assessment of safety and harm: bleeding, infections, electrolyte and metabolic disorders, seizures, cardiac arrhythmia, and renal replacement therapy.Conclusion: The TTM trial investigates potential benefit and harm of two target temperature strategies, both avoiding hyperthermia in a large proportion of the out-of-hospital cardiac arrest population.

AB - Background: Animal experimental studies and previous randomized trials suggest an improvement in mortality and neurological function with temperature regulation to hypothermia after cardiac arrest. According to a systematic review, previous trials were small, had a risk of bias, evaluated select populations, and did not treat hyperthermia in the control groups. The optimal target temperature management (TTM) strategy is not known. To prevent outcome reporting bias, selective reporting and data-driven results, we present the a priori defined detailed statistical analysis plan as an update to the previously published outline of the design and rationale for the TTM trial.Methods: The TTM trial is an investigator-initiated, multicenter, international, randomized, parallel-group, and assessor-blinded clinical trial of temperature management in 950 adult unconscious patients resuscitated after out-of-hospital cardiac arrest of a presumed cardiac cause. The patients are randomized to a TTM of either 33°C or 36°C after return of spontaneous circulation. The primary outcome is all-cause mortality at maximal follow-up (until end of the trial and a minimum of 180 days). The main secondary outcomes are the composite outcome of all-cause mortality and poor neurological function (Cerebral Performance Category (CPC) 3 and 4, and modified Rankin Scale (mRS) 4 and 5) at hospital discharge and at 180 days; and assessment of safety and harm: bleeding, infections, electrolyte and metabolic disorders, seizures, cardiac arrhythmia, and renal replacement therapy.Conclusion: The TTM trial investigates potential benefit and harm of two target temperature strategies, both avoiding hyperthermia in a large proportion of the out-of-hospital cardiac arrest population.

U2 - 10.1186/1745-6215-14-300

DO - 10.1186/1745-6215-14-300

M3 - Journal article

C2 - 24044764

SN - 1745-6215

VL - 14

SP - 1

EP - 8

JO - Trials

JF - Trials

IS - September

M1 - 300

ER -

Detailed statistical analysis plan for the target temperature management after out-of-hospital cardiac arrest trial

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