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Influence of temperature management at 33 °C versus normothermia on survival in patients with vasopressor support after out-of-hospital cardiac arrest : a post hoc analysis of the TTM-2 trial

Düring, Joachim LU orcid ; Annborn, Martin LU ; Cariou, Alain ; Chew, Michelle S. ; Dankiewicz, Josef LU orcid ; Friberg, Hans LU ; Haenggi, Matthias ; Haxhija, Zana LU orcid ; Jakobsen, Janus C. and Langeland, Halvor , et al. (2022) In Critical Care 26(1).
Abstract

Background: Targeted temperature management at 33 °C (TTM33) has been employed in effort to mitigate brain injury in unconscious survivors of out-of-hospital cardiac arrest (OHCA). Current guidelines recommend prevention of fever, not excluding TTM33. The main objective of this study was to investigate if TTM33 is associated with mortality in patients with vasopressor support on admission after OHCA. Methods: We performed a post hoc analysis of patients included in the TTM-2 trial, an international, multicenter trial, investigating outcomes in unconscious adult OHCA patients randomized to TTM33 versus normothermia. Patients were grouped according to level of circulatory support on admission: (1) no-vasopressor support, mean arterial... (More)

Background: Targeted temperature management at 33 °C (TTM33) has been employed in effort to mitigate brain injury in unconscious survivors of out-of-hospital cardiac arrest (OHCA). Current guidelines recommend prevention of fever, not excluding TTM33. The main objective of this study was to investigate if TTM33 is associated with mortality in patients with vasopressor support on admission after OHCA. Methods: We performed a post hoc analysis of patients included in the TTM-2 trial, an international, multicenter trial, investigating outcomes in unconscious adult OHCA patients randomized to TTM33 versus normothermia. Patients were grouped according to level of circulatory support on admission: (1) no-vasopressor support, mean arterial blood pressure (MAP) ≥ 70 mmHg; (2) moderate-vasopressor support MAP < 70 mmHg or any dose of dopamine/dobutamine or noradrenaline/adrenaline dose ≤ 0.25 µg/kg/min; and (3) high-vasopressor support, noradrenaline/adrenaline dose > 0.25 µg/kg/min. Hazard ratios with TTM33 were calculated for all-cause 180-day mortality in these groups. Results: The TTM-2 trial enrolled 1900 patients. Data on primary outcome were available for 1850 patients, with 662, 896, and 292 patients in the, no-, moderate-, or high-vasopressor support groups, respectively. Hazard ratio for 180-day mortality was 1.04 [98.3% CI 0.78–1.39] in the no-, 1.22 [98.3% CI 0.97–1.53] in the moderate-, and 0.97 [98.3% CI 0.68–1.38] in the high-vasopressor support groups with regard to TTM33. Results were consistent in an imputed, adjusted sensitivity analysis. Conclusions: In this exploratory analysis, temperature control at 33 °C after OHCA, compared to normothermia, was not associated with higher incidence of death in patients stratified according to vasopressor support on admission. Trial registration Clinical trials identifier NCT02908308, registered September 20, 2016.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Cardiac arrest, Heart arrest, Hypothermia induced, Mortality, Shock, Sudden
in
Critical Care
volume
26
issue
1
article number
231
publisher
BioMed Central (BMC)
external identifiers
  • pmid:35909163
  • scopus:85135198391
ISSN
1364-8535
DOI
10.1186/s13054-022-04107-9
language
English
LU publication?
yes
id
a33fc7d5-99d7-4390-aa37-e4a49861edb5
date added to LUP
2022-11-29 14:30:51
date last changed
2024-06-23 23:51:43
@article{a33fc7d5-99d7-4390-aa37-e4a49861edb5,
  abstract     = {{<p>Background: Targeted temperature management at 33 °C (TTM33) has been employed in effort to mitigate brain injury in unconscious survivors of out-of-hospital cardiac arrest (OHCA). Current guidelines recommend prevention of fever, not excluding TTM33. The main objective of this study was to investigate if TTM33 is associated with mortality in patients with vasopressor support on admission after OHCA. Methods: We performed a post hoc analysis of patients included in the TTM-2 trial, an international, multicenter trial, investigating outcomes in unconscious adult OHCA patients randomized to TTM33 versus normothermia. Patients were grouped according to level of circulatory support on admission: (1) no-vasopressor support, mean arterial blood pressure (MAP) ≥ 70 mmHg; (2) moderate-vasopressor support MAP &lt; 70 mmHg or any dose of dopamine/dobutamine or noradrenaline/adrenaline dose ≤ 0.25 µg/kg/min; and (3) high-vasopressor support, noradrenaline/adrenaline dose &gt; 0.25 µg/kg/min. Hazard ratios with TTM33 were calculated for all-cause 180-day mortality in these groups. Results: The TTM-2 trial enrolled 1900 patients. Data on primary outcome were available for 1850 patients, with 662, 896, and 292 patients in the, no-, moderate-, or high-vasopressor support groups, respectively. Hazard ratio for 180-day mortality was 1.04 [98.3% CI 0.78–1.39] in the no-, 1.22 [98.3% CI 0.97–1.53] in the moderate-, and 0.97 [98.3% CI 0.68–1.38] in the high-vasopressor support groups with regard to TTM33. Results were consistent in an imputed, adjusted sensitivity analysis. Conclusions: In this exploratory analysis, temperature control at 33 °C after OHCA, compared to normothermia, was not associated with higher incidence of death in patients stratified according to vasopressor support on admission. Trial registration Clinical trials identifier NCT02908308, registered September 20, 2016.</p>}},
  author       = {{Düring, Joachim and Annborn, Martin and Cariou, Alain and Chew, Michelle S. and Dankiewicz, Josef and Friberg, Hans and Haenggi, Matthias and Haxhija, Zana and Jakobsen, Janus C. and Langeland, Halvor and Taccone, Fabio Silvio and Thomas, Matthew and Ullén, Susann and Wise, Matt P. and Nielsen, Niklas}},
  issn         = {{1364-8535}},
  keywords     = {{Cardiac arrest; Heart arrest; Hypothermia induced; Mortality; Shock; Sudden}},
  language     = {{eng}},
  number       = {{1}},
  publisher    = {{BioMed Central (BMC)}},
  series       = {{Critical Care}},
  title        = {{Influence of temperature management at 33 °C versus normothermia on survival in patients with vasopressor support after out-of-hospital cardiac arrest : a post hoc analysis of the TTM-2 trial}},
  url          = {{http://dx.doi.org/10.1186/s13054-022-04107-9}},
  doi          = {{10.1186/s13054-022-04107-9}},
  volume       = {{26}},
  year         = {{2022}},
}