Jesper Johnsson1, Josefine Wahlström2, Josef Dankiewicz3, Martin Annborn4, Sachin Agarwal5, Allison Dupont6, Sune Forsberg7, Hans Friberg8, Robert Hand9, Karen G Hirsch10, Teresa May11, John A McPherson12, Michael R Mooney13, Nainesh Patel14, Richard R Riker11, Pascal Stammet15, Eldar Søreide16, David B Seder11, Niklas Nielsen4. 1. Department of Anaesthesiology and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden. Electronic address: jesper.johnsson@skane.se. 2. Department of Clinical Sciences, Lund University, Lund, Sweden. 3. Department of Cardiology, Skåne University Hospital, Lund, Sweden. 4. Department of Anaesthesiology and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden. 5. Department of Neurology, Columbia University Medical Center, New York City, United States. 6. Department of Cardiology, Eastern Georgia, United States. 7. Department of Intensive Care, Norrtälje Hospital, Center for Resuscitation Science, Karolinska Institute, Sweden. 8. Department of Clinical Sciences, Lund University, Intensive and Perioperative Care, Skåne University Hospital, Malmö, Sweden. 9. Department of Medical Services, Eastern Maine Medical Center, United States. 10. Department of Neurology, Stanford University, United States. 11. Department of Critical Care Services, Maine Medical Center, Portland, ME, United States. 12. Vanderbilt University Medical Center, Nashville, United States. 13. Minneapolis Heart Institute, Abbott North-Western Hospital, United States. 14. Department of Cardiology, Lehigh Valley Health Network, PA, United States. 15. Medical and Health Department, National Fire and Rescue Corps, Luxembourg. 16. Critical Care and Anaesthesiology Research Group, Stavanger University Hospital, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway.
Abstract
INTRODUCTION: Targeted temperature management (TTM) after out-of-hospital cardiac arrest (OHCA) has been recommended in international guidelines since 2005. The TTM-trial published in 2013 showed no difference in survival or neurological outcome for patients randomised to 33 °C or 36 °C, and many hospitals have changed practice. The optimal utilization of TTM is still debated. This study aimed to analyse if a difference in temperature goal was associated with outcome in an unselected international registry population. METHODS: This is a retrospective observational study based on a prospective registry - the International Cardiac Arrest Registry 2. Patients were categorized as receiving TTM in the lower range at 32-34 °C (TTM-low) or at 35-37 °C (TTM-high). Primary outcome was good functional status defined as cerebral performance category (CPC) of 1-2 at hospital discharge and secondary outcome was adverse events related to TTM. A logistic regression model was created to evaluate the independent effect of temperature by correcting for clinical and demographic factors associated with outcome. RESULTS: Of 1710 patients included, 1242 (72,6%) received TTM-low and 468 (27,4%) TTM-high. In patients receiving TTM-low, 31.3% survived with good outcome compared to 28.8% in the TTM-high group. There was no significant association between temperature and outcome (p = 0.352). In analyses adjusted for baseline differences the OR for a good outcome with TTM-low was 1.27, 95% CI (0.94-1.73). Haemodynamic instability leading to discontinuation of TTM was more common in TTM-low. CONCLUSIONS: No significant difference in functional outcome at hospital discharge was found in patients receiving lower- versus higher targeted temperature management.
INTRODUCTION: Targeted temperature management (TTM) after out-of-hospital cardiac arrest (OHCA) has been recommended in international guidelines since 2005. The TTM-trial published in 2013 showed no difference in survival or neurological outcome for patients randomised to 33 °C or 36 °C, and many hospitals have changed practice. The optimal utilization of TTM is still debated. This study aimed to analyse if a difference in temperature goal was associated with outcome in an unselected international registry population. METHODS: This is a retrospective observational study based on a prospective registry - the International Cardiac Arrest Registry 2. Patients were categorized as receiving TTM in the lower range at 32-34 °C (TTM-low) or at 35-37 °C (TTM-high). Primary outcome was good functional status defined as cerebral performance category (CPC) of 1-2 at hospital discharge and secondary outcome was adverse events related to TTM. A logistic regression model was created to evaluate the independent effect of temperature by correcting for clinical and demographic factors associated with outcome. RESULTS: Of 1710 patients included, 1242 (72,6%) received TTM-low and 468 (27,4%) TTM-high. In patients receiving TTM-low, 31.3% survived with good outcome compared to 28.8% in the TTM-high group. There was no significant association between temperature and outcome (p = 0.352). In analyses adjusted for baseline differences the OR for a good outcome with TTM-low was 1.27, 95% CI (0.94-1.73). Haemodynamic instability leading to discontinuation of TTM was more common in TTM-low. CONCLUSIONS: No significant difference in functional outcome at hospital discharge was found in patients receiving lower- versus higher targeted temperature management.
Authors: Niels T B Scholte; Christiaan van Wees; Wim J R Rietdijk; Marisa van der Graaf; Lucia S D Jewbali; Mathieu van der Jagt; Remco C M van den Berg; Mattie J Lenzen; Corstiaan A den Uil Journal: J Clin Med Date: 2022-03-24 Impact factor: 4.241