Targeted Temperature Management in Out-of-Hospital Cardiac Arrest With Shockable Rhythm: A Post Hoc Analysis of the Coronary Angiography After Cardiac Arrest Trial. Issue 2 (22nd September 2021)

• Record Type: Journal Article
• Authors: 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.;
• Is Part Of: Critical care medicine. Volume 50:Issue 2(2022)
• Page Start: e129
• Page End: e142
• Publication Date: 2021-09-22
• Subjects: cardiac arrest -- shockable rhythm -- targeted temperature management; Critical care medicine -- Periodicals; Soins intensifs -- Périodiques; 616.028
• DOI: 10.1097/CCM.0000000000005271
• Languages: English
• ISSNs: 0090-3493

Abstract

Abstract : Supplemental Digital Content is available in the text. 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. 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.