Marion Leary1, Marisa J Cinousis2, Mark E Mikkelsen3, David F Gaieski2, Benjamin S Abella4, Barry D Fuchs3. 1. Center for Resuscitation Science, Department of Emergency Medicine, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, United States. Electronic address: marion.leary@uphs.upenn.edu. 2. Center for Resuscitation Science, Department of Emergency Medicine, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, United States. 3. Section of Pulmonary Allergy and Critical Care, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, United States. 4. Center for Resuscitation Science, Department of Emergency Medicine, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, United States; Section of Pulmonary Allergy and Critical Care, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, United States.
Abstract
BACKGROUND: Evidence suggests that more rapid attainment of target temperature (32-34°C) improves neurologic outcome following cardiac arrest and targeted temperature management (TTM). It is unclear to what extent body mass index (BMI) is associated with the time to reach target temperature and subsequent clinical outcomes. OBJECTIVE: We sought to determine whether the time to target temperature was affected by BMI. In addition, we wished to determine whether the incidence of skin breakdown, survival to discharge and neurologic outcomes were associated with BMI. METHODS: Multicenter retrospective cohort study of cardiac arrest patients who underwent TTM between July 2007 and December 2012. We examined the association between BMI and the time from initiation of cooling to attainment of target temperature (32-34°C). RESULTS: Of 236 patients treated with TTM, 184 were included in the study. Mean age was 57.8±17.0 years; 78/184 (42%) were female and 48/184 (26%) had VF/VT as the initial rhythm. Median time to reach target temperature from ROSC was 6.4 (4.1, 9.8)h and median time from initiation of TTM to target temperature was 3.4 (2.1, 5.8)h. Cooling duration was a median of 24.0 (23.0, 24.0)h and median rewarming time was 12.0 (9.5, 18.0)h. Overall, 104/184 (56.5%) achieved target temperature within 4h and 128/184 (69.6%) within 6h. Increased BMI was associated with a longer time to achieve target temperature from initiation of TTM (p=0.01). There was no significant difference across BMI groups in time to achieve target temperature from ROSC (0.07), skin breakdown (p=0.35), survival (p=0.21), nor rate of good neurologic outcome (p=0.32). CONCLUSIONS: Target temperature was frequently achieved within 4-6h; as BMI increased, the time to reach target temperature from initiation of TTM was prolonged. There was no significant difference across BMI groups for survival or good neurologic outcome.
BACKGROUND: Evidence suggests that more rapid attainment of target temperature (32-34°C) improves neurologic outcome following cardiac arrest and targeted temperature management (TTM). It is unclear to what extent body mass index (BMI) is associated with the time to reach target temperature and subsequent clinical outcomes. OBJECTIVE: We sought to determine whether the time to target temperature was affected by BMI. In addition, we wished to determine whether the incidence of skin breakdown, survival to discharge and neurologic outcomes were associated with BMI. METHODS: Multicenter retrospective cohort study of cardiac arrestpatients who underwent TTM between July 2007 and December 2012. We examined the association between BMI and the time from initiation of cooling to attainment of target temperature (32-34°C). RESULTS: Of 236 patients treated with TTM, 184 were included in the study. Mean age was 57.8±17.0 years; 78/184 (42%) were female and 48/184 (26%) had VF/VT as the initial rhythm. Median time to reach target temperature from ROSC was 6.4 (4.1, 9.8)h and median time from initiation of TTM to target temperature was 3.4 (2.1, 5.8)h. Cooling duration was a median of 24.0 (23.0, 24.0)h and median rewarming time was 12.0 (9.5, 18.0)h. Overall, 104/184 (56.5%) achieved target temperature within 4h and 128/184 (69.6%) within 6h. Increased BMI was associated with a longer time to achieve target temperature from initiation of TTM (p=0.01). There was no significant difference across BMI groups in time to achieve target temperature from ROSC (0.07), skin breakdown (p=0.35), survival (p=0.21), nor rate of good neurologic outcome (p=0.32). CONCLUSIONS: Target temperature was frequently achieved within 4-6h; as BMI increased, the time to reach target temperature from initiation of TTM was prolonged. There was no significant difference across BMI groups for survival or good neurologic outcome.
Authors: Melissa I Naiman; Maria Gray; Joseph Haymore; Ahmed F Hegazy; Andrej Markota; Neeraj Badjatia; Erik B Kulstad Journal: J Vis Exp Date: 2017-11-21 Impact factor: 1.355
Authors: Guy Rozen; Gabby Elbaz-Greener; Ibrahim Marai; E Kevin Heist; Jeremy N Ruskin; Shemy Carasso; Edo Y Birati; Offer Amir Journal: Clin Cardiol Date: 2021-11-16 Impact factor: 2.882
Authors: Hyo Jin Bang; Kyu Nam Park; Chun Song Youn; Han Joon Kim; Sang Hoon Oh; Jee Yong Lim; Hwan Song; Soo Hyun Kim; Won Jung Jeong; Hyo Joon Kim Journal: PLoS One Date: 2022-03-29 Impact factor: 3.240