TY - JOUR
T1 - Targeted Temperature Management in Out-of-Hospital Cardiac Arrest With Shockable Rhythm
T2 - A Post Hoc Analysis of the Coronary Angiography After Cardiac Arrest Trial
AU - Spoormans, Eva M.
AU - Lemkes, Jorrit S.
AU - Janssens, Gladys N.
AU - van der Hoeven, Nina W.
AU - Jewbali, Lucia S.D.
AU - Dubois, Eric A.
AU - Meuwissen, Martijn
AU - Rijpstra, Tom A.
AU - Bosker, Hans A.
AU - Blans, Michiel J.
AU - Bleeker, Gabe B.
AU - Baak, Remon
AU - Vlachojannis, Georgios J.
AU - Eikemans, Bob J.W.
AU - Girbes, Armand R.J.
AU - van der Harst, Pim
AU - van der Horst, Iwan C.C.
AU - Voskuil, Michiel
AU - van der Heijden, Joris J.
AU - Beishuizen, Albertus
AU - Stoel, Martin
AU - Camaro, Cyril
AU - van der Hoeven, Hans
AU - Henriques, José P.
AU - Vlaar, Alexander P.J.
AU - Vink, Maarten A.
AU - van den Bogaard, Bas
AU - Heestermans, Ton A.C.M.
N1 - Publisher Copyright:
Copyright © 2021 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
PY - 2022/2/1
Y1 - 2022/2/1
N2 - 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. 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.
AB - 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. 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.
UR - https://www.scopus.com/pages/publications/85123969889
U2 - 10.1097/CCM.0000000000005271
DO - 10.1097/CCM.0000000000005271
M3 - Article
C2 - 34637414
AN - SCOPUS:85123969889
SN - 0090-3493
VL - 50
SP - E129-E142
JO - Critical Care Medicine
JF - Critical Care Medicine
IS - 2
ER -