Abstract
Aim
Time to Return of Spontaneous Circulation (ROSC) has a plausible relation to severity
of hypoxic injury before and during resuscitation in Out-of-Hospital Cardiac Arrest
(OHCA), and has consistently been associated with adverse outcome. The effect of Targeted
Temperature Management (TTM) may not be similar over the full spectrum of time to
ROSC. This study investigated the possible beneficial effect of targeting 33 °C over 36 °C on the prognostic importance of time to ROSC.
Methods
In predefined sub-study of the TTM-trial (NEJM 2013) we investigated the relationship
between time to ROSC, level of TTM and mortality and neurological outcome as assessed
by the Cerebral Performance Category (CPC) scale and modified Rankin Scale (mRS) after
180 days.
Results
Prolonged time to ROSC was significantly associated with increased mortality with
a hazard ratio (HR) of 1.02 per minute (95% CI 1.01–1.02). Level of TTM did not modify
the association of time to ROSC and mortality, pinteraction = 0.85. Prolonged time to ROSC was associated with reduced odds of surviving with a
favorable neurological outcome for CPC (p = 0.008 for CPC 1–2) and mRS (p = 0.17, mRS 0–3) with no significant interaction with level of TTM.
Conclusion
Time to ROSC remains a significant prognostic factor in comatose OHCA patients with
regards to risk of death and risk of adverse neurological outcome. For any time to
ROSC, targeting 33 °C in TTM was not associated with benefit with regards to reducing mortality or risk
of adverse neurological outcome compared to targeting 36 °C.
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Article info
Publication history
Published online: July 06, 2015
Accepted:
June 23,
2015
Received in revised form:
June 18,
2015
Received:
March 17,
2015
Identification
Copyright
© 2015 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
