Relationship between timing of cooling and outcomes in adult comatose cardiac arrest patients treated with targeted temperature management. (April 2017)

• Record Type: Journal Article
• Authors: Lee, Byung Kook; Jeung, Kyung Woon; Jung, Yong Hun; Lee, Dong Hun; Lee, Sung Min; Cho, Yong Soo; Heo, Tag; Yun, Jong Geun; Min, Yong Il
• Is Part Of: Resuscitation. Volume 113(2017)
• Page Start: 135
• Page End: 141
• Publication Date: 2017-04
• Subjects: TTM targeted temperature management -- ROSC restoration of spontaneous circulation -- CNUH Chonnam national university hospital -- ECMO extracorporeal membrane oxygenation -- CPR cardiopulmonary resuscitation -- GCS Glasgow coma scale -- SOFA sequential organ failure assessment -- CPC Cerebral Performance Categories -- OR odds ratio -- CI confidence interval; Heart arrest -- Induced hypothermia -- Body temperature regulation -- Prognosis; Resuscitation -- Periodicals; Resuscitation -- Periodicals; Réanimation -- Périodiques; Electronic journals; 616.025
• DOI: 10.1016/j.resuscitation.2016.12.002
• Languages: English
• ISSNs: 0300-9572

Abstract

Abstract: Aim of the study: Studies examining associations between time to target temperature and outcomes in cardiac arrest patients who underwent targeted temperature management (TTM) have shown inconsistent results. We examined these associations separately for time from restoration of spontaneous circulation to TTM initiation (pre-induction time) and time from TTM initiation to target temperature (induction time). Furthermore, we examined whether critical time thresholds exist if there is an association. Methods: This was a single-centre retrospective observational study including adult cardiac arrest patients treated with TTM from 2008 to 2015. We tested the associations of pre-induction time and induction time with outcomes at hospital discharge using multivariate logistic regression analysis. We then performed additional multivariate analyses, each with the significant timing variable at different binary cutoffs. Results: A total of 515 patients were analysed. At hospital discharge, 357 patients (69.3%) were alive, of whom 161 (31.3%) had a favourable neurologic outcome. In multivariate analysis, a shorter pre-induction time was independently associated with a favourable neurologic outcome (odds ratio [OR], 1.110; 95% confidence interval [CI], 1.025–1.202), whereas the induction time was not (OR, 0.954; 95% CI, 0.852–1.067). We found two pre-induction time thresholds (120 and 360 min) that were associated with neurologic outcome. Conclusion: We found that a shorter pre-induction time was independently associated with a favorable neurologic outcome at hospital discharge, whereas induction time was not. We also found two time thresholds at 120 and 360 min, after which initiation of cooling was associated with a worse neurologic outcome.