Targeted Temperature Management in Out-of-Hospital Cardiac Arrest With Shockable Rhythm: A Post Hoc Analysis of the Coronary Angiography After Cardiac Arrest Trial
Spoormans, Eva M; Lemkes, Jorrit S; Janssens, Gladys N; van der Hoeven, Nina W; Jewbali, Lucia S D; Dubois, Eric A; Meuwissen, Martijn; Rijpstra, Tom A; Bosker, Hans A; Blans, Michiel J; Bleeker, Gabe B; Baak, Remon; Vlachojannis, Georgios J; Eikemans, Bob J W; Girbes, Armand R J; van der Harst, Pim; van der Horst, Iwan C C; Voskuil, Michiel; van der Heijden, Joris J; Beishuizen, Albertus; Stoel, Martin; Camaro, Cyril; van der Hoeven, Hans; Henriques, José P; Vlaar, Alexander P J; Vink, Maarten A; van den Bogaard, Bas; Heestermans, Ton A C M; de Ruijter, Wouter; Delnoij, Thijs S R; Crijns, Harry J G M; Jessurun, Gillian A J; Oemrawsingh, Pranobe V; Gosselink, Marcel T M; Plomp, Koos; Magro, Michael; van de Ven, Peter M; van Royen, Niels; Elbers, Paul W G
(2022) Critical care medicine, volume 50, issue 2, pp. e129 - e142
(Article)
Abstract
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.
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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.
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Keywords: Cardiac arrest, Shockable rhythm, Targeted temperature management, Critical Care and Intensive Care Medicine, Journal Article
ISSN: 0090-3493
Publisher: Lippincott Williams and Wilkins
Note: Publisher Copyright: Copyright © 2021 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
(Peer reviewed)