Abstract
Aim
We aimed to investigate whether the effect of moderate hypothermia compared to normothermia
on survival outcomes after out-of-hospital cardiac arrest (OHCA) patients who underwent
targeted temperature management (TTM) differed between patients with and without initial
spontaneous hypothermia.
Methods
We used data from a nationwide OHCA database collected between 2016 and 2017. Adult
patients with OHCA of presumed cardiac aetiology who underwent TTM were included.
Moderate hypothermia was defined as a target temperature of TTM < 35.5 °C. Initial
hypothermia was defined as the measured temperature before starting TTM < 35.5 °C.
Endpoints were survival to discharge and good neurological recovery (CPC 1 or 2).
We compared outcomes between moderate hypothermia vs. normothermia using multivariable
logistic regression with an interaction term between target temperature of TTM and
initial spontaneous hypothermia.
Results
Of the 744 patients, 628 (84.4%) underwent moderate hypothermia. Initial spontaneous
hypothermia was observed in 28.5% and 25.0% in the moderate hypothermia and normothermia
groups, respectively. There was no significant difference in survival to discharge
between moderate hypothermia and normothermia (57.2% vs 62.9%, p = 0.248). The initial spontaneous hypothermia group showed poorer survival than the
initial non-hypothermia group (41.8% vs 64.4%, p < 0.001). In the interaction model, AOR (95% CI) for survival to discharge of moderate
hypothermia was 3.51 (1.33–9.25) in patients with initial spontaneous hypothermia
and 0.49 (0.27–0.89) in patients without initial spontaneous hypothermia.
Conclusion
The effect of moderate hypothermia was modified by the initial temperature of OHCA
survivors who underwent TTM. The positive effect of moderate hypothermia was increased
in patients with initial spontaneous hypothermia.
Abbreviations:
OHCA (out-of-hospital cardiac arrest), TTM (targeted temperature management)Keywords
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Article info
Publication history
Published online: April 12, 2020
Accepted:
April 3,
2020
Received in revised form:
March 28,
2020
Received:
January 22,
2020
Identification
Copyright
© 2020 Elsevier B.V. All rights reserved.
