Functional outcomes associated with varying levels of targeted temperature management after out-of-hospital cardiac arrest — An INTCAR2 registry analysis

Research output: Contribution to journalArticle

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.

Details

Authors
Organisations
External organisations
  • Helsingborg Hospital
  • Skåne University Hospital
  • Columbia University
  • The Mount Sinai Medical Center
  • Stockholm County Council
  • Eastern Maine Medical Center
  • Stanford University
  • Maine Medical Center
  • Vanderbilt University
  • Minneapolis Heart Institute
  • Lehigh Valley Health Network
  • National Fire and Rescue Corps
  • Stavanger University Hospital
  • University of Bergen
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Cardiac and Cardiovascular Systems

Keywords

  • Cardiac arrest, Out-of-hospital, Outcome, Targeted temperature management, TTM
Original languageEnglish
Pages (from-to)229-236
Number of pages8
JournalResuscitation
Volume146
Publication statusPublished - 2020 Jan 1
Publication categoryResearch
Peer-reviewedYes