Taro Irisawa1, Tasuku Matsuyama2, Taku Iwami3, Tomoki Yamada4, Koichi Hayakawa5, Kazuhisa Yoshiya3, Kazuo Noguchi6, Tetsuro Nishimura7, Toshifumi Uejima8, Yoshiki Yagi9, Takeyuki Kiguchi10, Masafumi Kishimoto11, Makoto Matsuura12, Yasuyuki Hayashi13, Taku Sogabe14, Takaya Morooka15, Tetsuhisa Kitamura16, Takeshi Shimazu17. 1. Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan. Electronic address: taroirisawa@gmail.com. 2. Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan. 3. Kyoto University Health Services, Kyoto, Japan. 4. Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan; Emergency and Critical Care Medical Center, Osaka Police Hospital, Osaka, Japan. 5. Department of Emergency and Critical Care Medicine, Kansai Medical University, Takii Hospital, Moriguchi, Japan. 6. Department of Emergency Medicine, Tane General Hospital, Osaka, Japan. 7. Department of Critical Care Medicine, Osaka City University, Osaka, Japan. 8. Department of Emergency and Critical Care Medicine, Kinki University School of Medicine, Osaka-Sayama, Japan. 9. Osaka Mishima Emergency Critical Care Center, Takatsuki, Japan. 10. Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan; Critical Care and Trauma Center, Osaka General Medical Center, Osaka, Japan. 11. Osaka Prefectural Nakakawachi Medical Center of Acute Medicine, Higashi, Osaka, Japan. 12. Senshu Trauma and Critical Care Center, Osaka, Japan. 13. Senri Critical Care Medical Center, Saiseikai Senri Hospital, Suita, Japan. 14. Traumatology and Critical Care Medical Center, National Hospital Organization Osaka National Hospital, Osaka, Japan. 15. Emergency and Critical Care Medical Center, Osaka City General Hospital, Osaka, Japan. 16. Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan. 17. Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan.
Abstract
BACKGROUND: It has been insufficiently investigated whether neurological function after out-of-hospital cardiac arrest (OHCA) would differ by 1 °C change in ordered target temperature of 33-36 °C among patients undergoing targeted temperature management (TTM) in the real-world setting. METHODS: This nationwide hospital-based observational study (The Japanese Association for Acute Medicine-OHCA Registry) conducted between June 2014 and December 2015 in Japan included OHCA patients aged ≥18 years who were treated with TTM. The primary outcome was one-month survival with neurologically favorable outcomes defined by cerebral performance category 1 or 2. To investigate the effect of TTM by 1 °C change in ordered target temperature of 33-36 °C on each outcome, random effects logistic regression analyses were performed. RESULTS: The final analysis included 738 patients. The proportion of patients with neurologically favorable outcome was 30.4% (7/23), 31.7% (175/552), 28.9% (11/38), and 30.4% (38/125) in the 33 °C, 34 °C, 35 °C, and 36 °C groups, respectively. In the multivariable logistic regression analysis, no group had a higher proportion of neurologically favorable outcome compared with the 34 °C group (vs. 33 °C group, adjusted odds ratio [AOR] 0.90; 95% confidence interval [CI] 0.25-3.12, vs. 35 °C group, AOR 1.17; 95% CI 0.44-3.13, vs. 36 °C group, AOR 1.26; 95% CI 0.78-2.02). CONCLUSIONS: In this population, we evaluated the difference in outcomes after adult OHCA patients received TTM by 1 °C change in ordered target temperature of 33-36 °C and demonstrated that there was no statistically significant difference in neurologically favorable outcomes after OHCA irrespective of target temperature.
BACKGROUND: It has been insufficiently investigated whether neurological function after out-of-hospital cardiac arrest (OHCA) would differ by 1 °C change in ordered target temperature of 33-36 °C among patients undergoing targeted temperature management (TTM) in the real-world setting. METHODS: This nationwide hospital-based observational study (The Japanese Association for Acute Medicine-OHCA Registry) conducted between June 2014 and December 2015 in Japan included OHCA patients aged ≥18 years who were treated with TTM. The primary outcome was one-month survival with neurologically favorable outcomes defined by cerebral performance category 1 or 2. To investigate the effect of TTM by 1 °C change in ordered target temperature of 33-36 °C on each outcome, random effects logistic regression analyses were performed. RESULTS: The final analysis included 738 patients. The proportion of patients with neurologically favorable outcome was 30.4% (7/23), 31.7% (175/552), 28.9% (11/38), and 30.4% (38/125) in the 33 °C, 34 °C, 35 °C, and 36 °C groups, respectively. In the multivariable logistic regression analysis, no group had a higher proportion of neurologically favorable outcome compared with the 34 °C group (vs. 33 °C group, adjusted odds ratio [AOR] 0.90; 95% confidence interval [CI] 0.25-3.12, vs. 35 °C group, AOR 1.17; 95% CI 0.44-3.13, vs. 36 °C group, AOR 1.26; 95% CI 0.78-2.02). CONCLUSIONS: In this population, we evaluated the difference in outcomes after adult OHCA patients received TTM by 1 °C change in ordered target temperature of 33-36 °C and demonstrated that there was no statistically significant difference in neurologically favorable outcomes after OHCA irrespective of target temperature.