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Outcomes after decrease in hypothermia usage for out of Hospital Cardiac arrest after targeted temperature management study

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Abstract

Objective

Evaluate trends in targeted temperature management with regards to temperature selection, its effect on neurologic outcomes at discharge, and compare this with recent large randomized controlled trial outcomes.

Design

Retrospective cohort study between January 2010 and December 2019.

Setting

Single large tertiary academic community hospital.

Patients

634 adult non-traumatic patients presenting with out of hospital cardiac arrest with persistent comatose state treated with active targeted temperature management.

Interventions, measurements, and Main results

473 patients received hypothermia of 33 °C and were compared to 161 patients who received targeted normothermia of 36.5 °C. The primary outcome was Cerebral Performance Category (CPC) at hospital discharge, with levels 1 or 2 considered good outcomes. Mortality, ICU days, ventilator days, and overall hospital stay length were secondary outcomes.

Patients receiving T33 had more favorable CPC outcomes when compared to patients receiving T36.5 (OR = 2.4 [1.3, 4.6], p = 0.006). Subgroup analysis of initial non-shockable rhythms demonstrated improved CPC scores (OR = 2.5, p = 0.04), however this was not maintained in the shockable rhythm group. T33 patients had a shorter length of stay. Mortality, ICU days, and ventilator days did not differ between the groups.

Conclusions

Out of hospital cardiac arrest patients with persistent comatose state treated with hypothermia of 33 °C had improved odds of discharge with good neurologic outcomes when compared to those treated with targeted normothermia. This improvement of outcomes appears to have been driven by the improved outcomes in the patients who had presented with non-shockable rhythm.

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Data Availability

The data that support the findings of this study are available from ChristianaCare Healthcare Systems but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of ChristianaCare Healthcare Systems.

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Acknowledgements

No significant acknowledgments by the authors.

Funding

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Author information

Authors and Affiliations

  1. Emergency Medicine and Internal Medicine Residency, ChristianaCare, Newark, DE, USA

    Dustin L. Slagle

  2. Institute for Research on Equity and Community Health, ChristianaCare, Newark, DE, USA

    Richard J. Caplan

  3. Division of Pulmonary and Critical Care, ChristianaCare, Newark, DE, USA

    Andrew R. Deitchman

  4. Department of Emergency Medicine, 4755 Ogletown Stanton Rd, 19718, Newark, DE, USA

    Dustin L. Slagle

Authors
  1. Dustin L. Slagle
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  2. Richard J. Caplan
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  3. Andrew R. Deitchman
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Contributions

DS abstracted the patient data. RC performed the statistical analysis. All authors (DS, RC, and AD) contributed significantly to the writing and creation of the manuscript and have read and approved the final manuscript.

Corresponding author

Correspondence to Dustin L. Slagle.

Ethics declarations

Ethics approval and consent to participate:

Review was conducted after ChristianaCare Institutional Review Board approval, CCC# 40058, DDD# 604657.

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Not applicable.

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Slagle, D.L., Caplan, R.J. & Deitchman, A.R. Outcomes after decrease in hypothermia usage for out of Hospital Cardiac arrest after targeted temperature management study. J Clin Monit Comput 37, 261–266 (2023). https://doi.org/10.1007/s10877-022-00887-1

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  • DOI: https://doi.org/10.1007/s10877-022-00887-1

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