Journal article
Time to start of cardiopulmonary resuscitation and the effect of target temperature management at 33°C and 36°C.
- Dankiewicz J Department of Intensive and Perioperative Care, Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden. Electronic address: josef.dankiewicz@gmail.com.
- Friberg H Department of Intensive and Perioperative Care, Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden.
- Bělohlávek J 2nd Department of Cardiovascular Internal Medicine, First Medical Faculty, Charles University, Prague and General Teaching Hospital of Prague, Prague, Czech Republic.
- Walden A Department of Intensive Care, Royal Berkshire Hospital, Reading, United Kingdom.
- Hassager C Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
- Cronberg T Department of Intensive and Perioperative Care, Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden.
- Erlinge D Department of Intensive and Perioperative Care, Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden.
- Gasche Y Department of Intensive Care, Geneva University Hospital, Geneva, Switzerland.
- Hovdenes J Department of Anesthesiology, Rikshospitalet, Oslo University Hospital, Oslo, Norway.
- Horn J Department of Intensive Care, Academic Medical Centre, Amsterdam, The Netherlands.
- Kjaergaard J Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
- Kuiper M Department of Intensive Care, Leeuwarden Hospital, Leeuwarden, The Netherlands.
- Pellis T Department of Intensive Care, Santa Maria degli Ángeli, Pordenone, Italy.
- Stammet P Department of Anesthesiology and Intensive Care, Centre Hospitalier de Luxembourg, Luxembourg City, Luxembourg.
- Wanscher M The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
- Wetterslev J Copenhagen Trial Unit, Centre of Clinical Intervention Research, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
- Wise M Adult Critical Care, University Hospital of Wales, Cardiff, United Kingdom.
- Åneman A Department of Intensive Care, Liverpool Hospital, Sydney, NSW, Australia.
- Nielsen N Department of Clinical Sciences, Lund University, Lund, Sweden; Department of Anesthesiology and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden.
- 2015-12-27
Published in:
- Resuscitation. - 2016
Cardiac arrest
Neurological function
Targeted temperature management
Aged
Body Temperature
Cardiopulmonary Resuscitation
Female
Humans
Male
Middle Aged
Out-of-Hospital Cardiac Arrest
Time Factors
English
INTRODUCTION
The optimal temperature during targeted temperature management (TTM) for comatose patients resuscitated from out-of-hospital cardiac arrest is unknown. It has been hypothesized that patients with long no-flow times, for example those without bystander CPR would have the most to gain from temperature management at lower temperatures.
METHODS
We analysed data from an international clinical trial randomizing cardiac arrest patients to targeted temperature management at 33°C and 36°C for an interaction between no-flow time and intervention group, with neurological function at six months after cardiac arrest as the primary outcome. A cerebral performance category (CPC) score of 1 or 2 was considered a good outcome.
RESULTS
No-flow time (min) was associated with poor neurological outcome (OR 1.13, 95% confidence interval 1.06-1.20, p<0.001). There was no statistically significant interaction between no flow-time and intervention group (p=0.11), which may imply that the non-superior effect of 33°C was consistent for all no-flow times. Bystander CPR was not independently associated with neurological function.
CONCLUSIONS
TTM at 33°C compared to 36°C was not associated with an increased probability of a good neurological function for patients with longer no-flow times.
The optimal temperature during targeted temperature management (TTM) for comatose patients resuscitated from out-of-hospital cardiac arrest is unknown. It has been hypothesized that patients with long no-flow times, for example those without bystander CPR would have the most to gain from temperature management at lower temperatures.
METHODS
We analysed data from an international clinical trial randomizing cardiac arrest patients to targeted temperature management at 33°C and 36°C for an interaction between no-flow time and intervention group, with neurological function at six months after cardiac arrest as the primary outcome. A cerebral performance category (CPC) score of 1 or 2 was considered a good outcome.
RESULTS
No-flow time (min) was associated with poor neurological outcome (OR 1.13, 95% confidence interval 1.06-1.20, p<0.001). There was no statistically significant interaction between no flow-time and intervention group (p=0.11), which may imply that the non-superior effect of 33°C was consistent for all no-flow times. Bystander CPR was not independently associated with neurological function.
CONCLUSIONS
TTM at 33°C compared to 36°C was not associated with an increased probability of a good neurological function for patients with longer no-flow times.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1016/j.resuscitation.2015.10.013
- PMID 26705972
- Persistent URL
- https://sonar.ch/global/documents/192636
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