Anders Morten Grejs1, Bent Roni Ranghøj Nielsen2, Peter Juhl-Olsen3, Jakob Gjedsted3, Erik Sloth3, Johan Heiberg3, Christian Alcaraz Frederiksen2, Anni Nørgaard Jeppesen4, Christophe Henri Valdemar Duez5, Per Dreyer Hamre6, Eldar Søreide7, Hans Kirkegaard5. 1. Research Center for Emergency Medicine, Aarhus University Hospital, Nørrebrogade 44, DK-8000 Aarhus C, Denmark; Department of Anaesthesiology and Intensive Care Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark; Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, DK-8200 Aarhus N, Denmark; Department of Anaesthesiology, Regional Hospital Horsens, Sundvej 30, DK-8700 Horsens, Denmark. Electronic address: anders.grejs@dadlnet.dk. 2. Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, DK-8200 Aarhus N, Denmark; Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark. 3. Department of Anaesthesiology and Intensive Care Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark; Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, DK-8200 Aarhus N, Denmark. 4. Research Center for Emergency Medicine, Aarhus University Hospital, Nørrebrogade 44, DK-8000 Aarhus C, Denmark; Department of Anaesthesiology and Intensive Care Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark; Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, DK-8200 Aarhus N, Denmark. 5. Research Center for Emergency Medicine, Aarhus University Hospital, Nørrebrogade 44, DK-8000 Aarhus C, Denmark; Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, DK-8200 Aarhus N, Denmark. 6. Department of Cardiology, Stavanger University Hospital, Armauer Hansens Vei 20, NO-4011 Stavanger, Norway. 7. Department of Anaesthesiology and Intensive Care, Stavanger University Hospital, Armauer Hansens vei 20, NO-4011 Stavanger, Norway; Department of Clinical Medicine, University of Bergen, Jonas Lies Veg 91B, N.5021 Bergen, Norway.
Abstract
AIM: To evaluate post-cardiac arrest myocardial dysfunction during prolonged targeted temperature management (TTM) compared with standard TTM in comatose out-of-hospital cardiac arrest (OHCA) survivors. METHODS: A randomised, controlled trial comparing myocardial function after TTM at 33 ±1°C for 48h compared with 24h. A total of 105 OHCA patients were computer-randomised to 24h (n=50) or 48h (n=55) of TTM. Transthoracic echocardiography was performed after 24h, 48h and 72h. Echocardiographic parameters were evaluated by an investigator who was blinded to randomisation. The primary endpoint was peak systolic mitral annular velocity (Ś) measured as the difference in the period from 24h to 72h. The model was adjusted for age, primary rhythm and heart rate. The secondary outcomes were global peak longitudinal strain, left ventricular ejection fraction (LVEF), tricuspid annular plane systolic excursion (TAPSE) and the diastolic measures e' and E/e'. RESULTS: The mean difference of S' was significantly increased in the 48h group compared with the 24h group: -1.14cm/s (-1.83; -0.45), p=0.001. This difference was consistent after adjusting the data (p=0.008). However, there were no significant changes between the study groups with respect to the adjusted secondary outcomes of global peak longitudinal strain (p=0.07), LVEF (p=0.31), TAPSE (p=0.91), e' (p=0.26) and E/e' (p=0.18). CONCLUSION:Prolonged TTM at 33°C of 48h compared with 24h in comatose OHCA survivors may improve the recovery of post-cardiac arrest left myocardial dysfunction demonstrated by the echocardiographic outcome, S'. ClinicalTrials.gov identifier: NCT02066753.
RCT Entities:
AIM: To evaluate post-cardiac arrest myocardial dysfunction during prolonged targeted temperature management (TTM) compared with standard TTM in comatose out-of-hospital cardiac arrest (OHCA) survivors. METHODS: A randomised, controlled trial comparing myocardial function after TTM at 33 ±1°C for 48h compared with 24h. A total of 105 OHCA patients were computer-randomised to 24h (n=50) or 48h (n=55) of TTM. Transthoracic echocardiography was performed after 24h, 48h and 72h. Echocardiographic parameters were evaluated by an investigator who was blinded to randomisation. The primary endpoint was peak systolic mitral annular velocity (Ś) measured as the difference in the period from 24h to 72h. The model was adjusted for age, primary rhythm and heart rate. The secondary outcomes were global peak longitudinal strain, left ventricular ejection fraction (LVEF), tricuspid annular plane systolic excursion (TAPSE) and the diastolic measures e' and E/e'. RESULTS: The mean difference of S' was significantly increased in the 48h group compared with the 24h group: -1.14cm/s (-1.83; -0.45), p=0.001. This difference was consistent after adjusting the data (p=0.008). However, there were no significant changes between the study groups with respect to the adjusted secondary outcomes of global peak longitudinal strain (p=0.07), LVEF (p=0.31), TAPSE (p=0.91), e' (p=0.26) and E/e' (p=0.18). CONCLUSION: Prolonged TTM at 33°C of 48h compared with 24h in comatose OHCA survivors may improve the recovery of post-cardiac arrest left myocardial dysfunction demonstrated by the echocardiographic outcome, S'. ClinicalTrials.gov identifier: NCT02066753.
Authors: Thomas Hvid Jensen; Peter Juhl-Olsen; Bent Roni Ranghøj Nielsen; Johan Heiberg; Christophe Henri Valdemar Duez; Anni Nørgaard Jeppesen; Christian Alcaraz Frederiksen; Hans Kirkegaard; Anders Morten Grejs Journal: Scand J Trauma Resusc Emerg Med Date: 2021-02-19 Impact factor: 2.953