Leda Nobile1, Irene Lamanna2, Vito Fontana2, Katia Donadello2, Antonio Maria Dell'anna2, Jacques Creteur2, Jean-Louis Vincent2, Federico Pappalardo3, Fabio Silvio Taccone4. 1. Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik, 808, 1070 Brussels, Belgium; Department of Cardiovascular and Thoracic Surgery, Cardiovascular Anaesthesia and Intensive Care, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy. 2. Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik, 808, 1070 Brussels, Belgium. 3. Department of Cardiovascular and Thoracic Surgery, Cardiovascular Anaesthesia and Intensive Care, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy. 4. Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik, 808, 1070 Brussels, Belgium. Electronic address: ftaccone@ulb.ac.be.
Abstract
AIM: Spontaneous alterations in temperature homeostasis after cardiac arrest (CA) are associated with worse outcome. However, it remains unclear the prognostic role of temperature variability (TV) during cooling procedures. We hypothesized that low TV during targeted temperature management (TTM) would be associated with a favourable neurological outcome after CA. METHODS: We reviewed data from all comatose patients after in-hospital or out-of-hospital CA admitted to our Department of Intensive Care between December 2006 and January 2014 who underwent TTM (32-34°C) and survived at least 24h. We collected demographic data, CA characteristics, intensive care unit (ICU) survival and neurological outcome at three months (favourable neurological outcome was defined as cerebral performance category 1-2). TV was expressed using the standard deviation (SD) of all temperature measurements during hypothermia; high TV was defined as an SD >1°C. RESULTS: Of the 301 patients admitted over the study period, 72 patients were excluded and a total of 229 patients were studied; 88 had a favourable neurological outcome. The median temperature on ICU admission was 35.8 [34.9-36.9]°C and the median time to hypothermia (body temperature <34°C), was 4 [3-7] h. Median TV was 0.9 [0.6-1.0]°C and 57 patients (25%) had high TV. In multivariable logistic regression, witnessed CA, ventricular fibrillation/tachycardia and previous neurological disease were independent risk factors for high TV. Younger age, bystander cardiopulmonary resuscitation, shorter time to return of spontaneous circulation, cardiac origin of arrest, shockable rhythm and longer time to target temperature were independent predictors of favourable neurological outcome, but TV was not. CONCLUSIONS: Among comatose survivors treated with TTM after CA, 25% of patients had high TV; however, this was not associated with a worse neurologic outcome.
AIM: Spontaneous alterations in temperature homeostasis after cardiac arrest (CA) are associated with worse outcome. However, it remains unclear the prognostic role of temperature variability (TV) during cooling procedures. We hypothesized that low TV during targeted temperature management (TTM) would be associated with a favourable neurological outcome after CA. METHODS: We reviewed data from all comatosepatients after in-hospital or out-of-hospital CA admitted to our Department of Intensive Care between December 2006 and January 2014 who underwent TTM (32-34°C) and survived at least 24h. We collected demographic data, CA characteristics, intensive care unit (ICU) survival and neurological outcome at three months (favourable neurological outcome was defined as cerebral performance category 1-2). TV was expressed using the standard deviation (SD) of all temperature measurements during hypothermia; high TV was defined as an SD >1°C. RESULTS: Of the 301 patients admitted over the study period, 72 patients were excluded and a total of 229 patients were studied; 88 had a favourable neurological outcome. The median temperature on ICU admission was 35.8 [34.9-36.9]°C and the median time to hypothermia (body temperature <34°C), was 4 [3-7] h. Median TV was 0.9 [0.6-1.0]°C and 57 patients (25%) had high TV. In multivariable logistic regression, witnessed CA, ventricular fibrillation/tachycardia and previous neurological disease were independent risk factors for high TV. Younger age, bystander cardiopulmonary resuscitation, shorter time to return of spontaneous circulation, cardiac origin of arrest, shockable rhythm and longer time to target temperature were independent predictors of favourable neurological outcome, but TV was not. CONCLUSIONS: Among comatose survivors treated with TTM after CA, 25% of patients had high TV; however, this was not associated with a worse neurologic outcome.
Authors: Lorenzo Calabró; Wulfran Bougouin; Alain Cariou; Chiara De Fazio; Markus Skrifvars; Eldar Soreide; Jacques Creteur; Hans Kirkegaard; Stéphane Legriel; Jean-Baptiste Lascarrou; Bruno Megarbane; Nicolas Deye; Fabio Silvio Taccone Journal: Crit Care Date: 2019-08-23 Impact factor: 9.097