Abstract
Aim
Target temperature management (TTM) is used in comatose post-cardiac arrest patients,
but the recommended temperature range is wide. This study aimed to assess the effectiveness
of TTM at 32–34 °C while considering the degree of cerebral injury and cerebral circulation,
as assessed by regional cerebral oxygen saturation (rSO2).
Methods
This is a secondary analysis of prospectively collected registry data from comatose
patients who were transferred to 15 hospitals in Japan after out-of-hospital cardiac
arrest (OHCA) from 2011 to 2013. The primary outcome was all-cause mortality at 90 days
after OHCA, and the secondary outcome was favorable neurological outcomes as evaluated
according to the Cerebral Performance Category. We monitored rSO2 noninvasively with near-infrared spectroscopy, which could assess cerebral perfusion
and the balance of oxygen delivery and uptake.
Results
We stratified 431 study patients into three groups according to rSO2 on hospital arrival: rSO2 ≤40% (n = 296), rSO2 41–60% (n = 67), and rSO2 ≥61% (n = 68). Propensity score analysis revealed that TTM at 32–34 °C decreased
all-cause mortality in patients with rSO2 41–60% (average treatment effect on treated [ATT] by propensity score matching [PSM]
−0.51, 95%CI −0.70 to −0.33; ATT by inverse probability of treatment weighting [IPW]
−0.52, 95%CI −0.71 to −0.34), and increased favorable neurological outcomes in patients
with rSO2 41–60% (ATT by PSM 0.50, 95%CI 0.32–0.68; ATT by IPW 0.52, 95%CI 0.35–0.69).
Conclusion
TTM at 32–34 °C effectively decreased all-cause mortality in comatose OHCA patients
with rSO2 41–60% on hospital arrival in Japan.
Keywords
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Article info
Publication history
Published online: February 09, 2018
Accepted:
February 6,
2018
Received in revised form:
January 19,
2018
Received:
September 5,
2017
Footnotes
☆A Spanish translated version of the abstract of this article appears as Appendixi n the final online version at https://doi.org/10.1016/j.resuscitation.2018.02.007
Identification
Copyright
© 2018 Elsevier B.V. All rights reserved.
