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

Johnsson, Jesper LU ; Wahlström, Josefine ; Dankiewicz, Josef LU orcid ; Annborn, Martin LU ; Agarwal, Sachin ; Dupont, Allison ; Forsberg, Sune ; Friberg, Hans LU ; Hand, Robert and Hirsch, Karen G. , et al. (2020) In Resuscitation 146. p.229-236
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... (More)

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.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Cardiac arrest, Out-of-hospital, Outcome, Targeted temperature management, TTM
in
Resuscitation
volume
146
pages
8 pages
publisher
Elsevier
external identifiers
  • scopus:85075875503
  • pmid:31706964
ISSN
0300-9572
DOI
10.1016/j.resuscitation.2019.10.020
language
English
LU publication?
yes
id
a8f01edb-dcb7-43d3-9dce-b58fd5a849d5
date added to LUP
2021-01-11 15:34:50
date last changed
2024-06-13 04:14:42
@article{a8f01edb-dcb7-43d3-9dce-b58fd5a849d5,
  abstract     = {{<p>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.</p>}},
  author       = {{Johnsson, Jesper and Wahlström, Josefine and Dankiewicz, Josef and Annborn, Martin and Agarwal, Sachin and Dupont, Allison and Forsberg, Sune and Friberg, Hans and Hand, Robert and Hirsch, Karen G. and May, Teresa and McPherson, John A. and Mooney, Michael R. and Patel, Nainesh and Riker, Richard R. and Stammet, Pascal and Søreide, Eldar and Seder, David B. and Nielsen, Niklas}},
  issn         = {{0300-9572}},
  keywords     = {{Cardiac arrest; Out-of-hospital; Outcome; Targeted temperature management; TTM}},
  language     = {{eng}},
  month        = {{01}},
  pages        = {{229--236}},
  publisher    = {{Elsevier}},
  series       = {{Resuscitation}},
  title        = {{Functional outcomes associated with varying levels of targeted temperature management after out-of-hospital cardiac arrest — An INTCAR2 registry analysis}},
  url          = {{http://dx.doi.org/10.1016/j.resuscitation.2019.10.020}},
  doi          = {{10.1016/j.resuscitation.2019.10.020}},
  volume       = {{146}},
  year         = {{2020}},
}