TY - JOUR
T1 - Targeted Temperature Management in Out-of-Hospital Cardiac Arrest With Shockable Rhythm
T2 - A Post Hoc Analysis of the Coronary Angiography After Cardiac Arrest Trial
AU - Spoormans, Eva M
AU - Lemkes, Jorrit S
AU - Janssens, Gladys N
AU - van der Hoeven, Nina W
AU - Jewbali, Lucia S D
AU - Dubois, Eric A
AU - Meuwissen, Martijn
AU - Rijpstra, Tom A
AU - Bosker, Hans A
AU - Blans, Michiel J
AU - Bleeker, Gabe B
AU - Baak, Remon
AU - Vlachojannis, Georgios J
AU - Eikemans, Bob J W
AU - Girbes, Armand R J
AU - van der Harst, Pim
AU - van der Horst, Iwan C C
AU - Voskuil, Michiel
AU - van der Heijden, Joris J
AU - Beishuizen, Albertus
AU - Stoel, Martin
AU - Camaro, Cyril
AU - van der Hoeven, Hans
AU - Henriques, José P
AU - Vlaar, Alexander P J
AU - Vink, Maarten A
AU - van den Bogaard, Bas
AU - Heestermans, Ton A C M
AU - de Ruijter, Wouter
AU - Delnoij, Thijs S R
AU - Crijns, Harry J G M
AU - Jessurun, Gillian A J
AU - Oemrawsingh, Pranobe V
AU - Gosselink, Marcel T M
AU - Plomp, Koos
AU - Magro, Michael
AU - van de Ven, Peter M
AU - van Royen, Niels
AU - Elbers, Paul W G
N1 - Copyright © 2021 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
PY - 2022/2/1
Y1 - 2022/2/1
N2 - OBJECTIVES: The optimal targeted temperature in patients with shockable rhythm is unclear, and current guidelines recommend targeted temperature management with a correspondingly wide range between 32°C and 36°C. Our aim was to study survival and neurologic outcome associated with targeted temperature management strategy in postarrest patients with initial shockable rhythm.DESIGN: Observational substudy of the Coronary Angiography after Cardiac Arrest without ST-segment Elevation trial.SETTING: Nineteen hospitals in The Netherlands.PATIENTS: The Coronary Angiography after Cardiac Arrest trial randomized successfully resuscitated patients with shockable rhythm and absence of ST-segment elevation to a strategy of immediate or delayed coronary angiography. In this substudy, 459 patients treated with mild therapeutic hypothermia (32.0-34.0°C) or targeted normothermia (36.0-37.0°C) were included. Allocation to targeted temperature management strategy was at the discretion of the physician.INTERVENTIONS: None.MEASUREMENTS AND MAIN RESULTS: After 90 days, 171 patients (63.6%) in the mild therapeutic hypothermia group and 129 (67.9%) in the targeted normothermia group were alive (hazard ratio, 0.86 [95% CI, 0.62-1.18]; log-rank p = 0.35; adjusted odds ratio, 0.89; 95% CI, 0.45-1.72). Patients in the mild therapeutic hypothermia group had longer ICU stay (4 d [3-7 d] vs 3 d [2-5 d]; ratio of geometric means, 1.32; 95% CI, 1.15-1.51), lower blood pressures, higher lactate levels, and increased need for inotropic support. Cerebral Performance Category scores at ICU discharge and 90-day follow-up and patient-reported Mental and Physical Health Scores at 1 year were similar in the two groups.CONCLUSIONS: In the context of out-of-hospital cardiac arrest with shockable rhythm and no ST-elevation, treatment with mild therapeutic hypothermia was not associated with improved 90-day survival compared with targeted normothermia. Neurologic outcomes at 90 days as well as patient-reported Mental and Physical Health Scores at 1 year did not differ between the groups.
AB - OBJECTIVES: The optimal targeted temperature in patients with shockable rhythm is unclear, and current guidelines recommend targeted temperature management with a correspondingly wide range between 32°C and 36°C. Our aim was to study survival and neurologic outcome associated with targeted temperature management strategy in postarrest patients with initial shockable rhythm.DESIGN: Observational substudy of the Coronary Angiography after Cardiac Arrest without ST-segment Elevation trial.SETTING: Nineteen hospitals in The Netherlands.PATIENTS: The Coronary Angiography after Cardiac Arrest trial randomized successfully resuscitated patients with shockable rhythm and absence of ST-segment elevation to a strategy of immediate or delayed coronary angiography. In this substudy, 459 patients treated with mild therapeutic hypothermia (32.0-34.0°C) or targeted normothermia (36.0-37.0°C) were included. Allocation to targeted temperature management strategy was at the discretion of the physician.INTERVENTIONS: None.MEASUREMENTS AND MAIN RESULTS: After 90 days, 171 patients (63.6%) in the mild therapeutic hypothermia group and 129 (67.9%) in the targeted normothermia group were alive (hazard ratio, 0.86 [95% CI, 0.62-1.18]; log-rank p = 0.35; adjusted odds ratio, 0.89; 95% CI, 0.45-1.72). Patients in the mild therapeutic hypothermia group had longer ICU stay (4 d [3-7 d] vs 3 d [2-5 d]; ratio of geometric means, 1.32; 95% CI, 1.15-1.51), lower blood pressures, higher lactate levels, and increased need for inotropic support. Cerebral Performance Category scores at ICU discharge and 90-day follow-up and patient-reported Mental and Physical Health Scores at 1 year were similar in the two groups.CONCLUSIONS: In the context of out-of-hospital cardiac arrest with shockable rhythm and no ST-elevation, treatment with mild therapeutic hypothermia was not associated with improved 90-day survival compared with targeted normothermia. Neurologic outcomes at 90 days as well as patient-reported Mental and Physical Health Scores at 1 year did not differ between the groups.
KW - 33-DEGREES-C
KW - 36-DEGREES-C
KW - ASSOCIATION
KW - CARE
KW - COMATOSE SURVIVORS
KW - EPIDEMIOLOGY
KW - EUROPEAN RESUSCITATION COUNCIL
KW - HYPOTHERMIA
KW - INJURY
KW - INTERVENTION
KW - cardiac arrest
KW - shockable rhythm
KW - targeted temperature management
U2 - 10.1097/CCM.0000000000005271
DO - 10.1097/CCM.0000000000005271
M3 - Article
C2 - 34637414
SN - 0090-3493
VL - 50
SP - e129-e142
JO - Critical Care Medicine
JF - Critical Care Medicine
IS - 2
ER -