Abstract
Objective
For comatose survivors of out-of-hospital cardiac arrest (OHCA), current guidelines
recommend targeted temperature management (TTM) with a goal temperature of 32 °C–36 °C
for at least 24 h. We examined adherence to temperature targets, quantified as time-in-therapeutic
range (TTR), and association of TTR with survival and neurologic outcomes.
Methods
We conducted a retrospective cohort study of the Resuscitation Outcomes Consortium-Continuous
Chest Compressions trial, including adults with OHCA who underwent TTM for >12 h.
We imputed continuous temperatures between consecutive temperature measurements using
the linear interpolation method and calculated TTR for multiple target temperatures.
The association of TTR with survival to hospital discharge and favorable neurological
outcome was evaluated using hierarchical regression models.
Main results
Among 2,637 patients (mean age 62.3 years, 29.9 % female), the median duration of
TTR for TTM between 32 °C–36 °C was 23 (IQR: 21–24) hours with a median time outside
therapeutic range of 0.9 (IQR: 0.0–4.2) hours. In risk-adjusted analyses, there was
no association of TTR of 32 °C–36 °C with overall survival (OR 1.00 [95 % CI, 0.90–1.10])
or favorable neurologic outcome (1.02 [95 % CI, 0.90–1.14]). However, in assessments
of TTR 33 °C–36 °C, there was a significant association with favorable neurologic
survival (OR 1.12 [1.01–1.25]) but not overall survival (OR 1.04 [0.94–1.15]).
Conclusions
Among patients with OHCA who underwent TTM, we found variability in adherence to guideline-recommended
treatment targets. Higher TTR was not associated with overall survival, but for certain
temperature thresholds, TTR was associated with favorable neurologic outcome.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to ResuscitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Heart Disease and Stroke Statistics—2017 Update: A Report From the American Heart Association.Circulation. 2017; 135: e146-e603
- Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.Circulation. 2020; 142: S366-S468
- European Resuscitation Council and European Society of Intensive Care Medicine Guidelines for Post-resuscitation Care 2015: Section 5 of the European Resuscitation Council Guidelines for Resuscitation 2015.Resuscitation. 2015; 95: 202-222
- Mild Therapeutic Hypothermia to Improve the Neurologic Outcome after Cardiac Arrest.N Engl J Med. 2002; 346: 549-556
- Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia.N Engl J Med. 2002; 346: 557-563
- Targeted Temperature Management for Cardiac Arrest with Nonshockable Rhythm.N Engl J Med. 2019; 381: 2327-2337
- Hypothermia versus Normothermia after Out-of-Hospital Cardiac Arrest.N Engl J Med. 2021; 384: 2283-2294
- Targeted Temperature Management at 33°C versus 36°C after Cardiac Arrest.N Engl J Med. 2013; 369: 2197-2206
- A Randomized Trial of Continuous Versus Interrupted Chest Compressions in Out-of-Hospital Cardiac Arrest: Rationale for and Design of the Resuscitation Outcomes Consortium CCC Trial.Am Heart J. 2015; 169: 334-341
- Trial of Continuous or Interrupted Chest Compressions during CPR.N Engl J Med. 2015; 373: 2203-2214
- Hospital Variation in Time to Epinephrine for Nonshockable In-Hospital Cardiac Arrest.Circulation. 2016; 134: 2105-2114
- Association Between Therapeutic Hypothermia and Survival After In-Hospital Cardiac Arrest.JAMA. 2016; 316: 1375-1382
- Predictors of Survival From Out-of-Hospital Cardiac Arrest.Circ Cardiovasc Qual Outcomes. 2010; 3: 63-81
- MissForest—non-parametric missing value imputation for mixed-type data.Bioinformatics. 2012; 28: 112-118
- Temperature Management After Cardiac Arrest.Circulation. 2015; 132: 2448-2456
- Estimation of the impact of warfarin’s time-in-therapeutic range on stroke and major bleeding rates and its influence on the medical cost avoidance associated with novel oral anticoagulant use-learnings from ARISTOTLE, ROCKET-AF, and RE-LY trials.J Thromb Thrombolysis. 2014; 38: 150-159
- Cerebral Vascular Accidents in Patients over the Age of 60: II. Prognosis.Scott Med J. 1957; 2: 200-215
- A brief conceptual tutorial of multilevel analysis in social epidemiology: using measures of clustering in multilevel logistic regression to investigate contextual phenomena.J Epidemiol Community Health. 2006; 60: 290-297
- Fitting Linear Mixed-Effects Models Using lme4.J Stat Softw. 2015; 67: 1-48
- Hospital Variation in the Utilization and Implementation of Targeted Temperature Management in Out-of-Hospital Cardiac Arrest.Circ Cardiovasc Qual Outcomes. 2018; 11: e004829
Article info
Publication history
Published online: November 25, 2022
Accepted:
November 18,
2022
Received in revised form:
November 15,
2022
Received:
July 21,
2022
Identification
Copyright
© 2022 Elsevier B.V. All rights reserved.
