Infectious complications after out-of-hospital cardiac arrest: A comparison between two target temperatures

TY - JOUR

T1 - Infectious complications after out-of-hospital cardiac arrest

T2 - A comparison between two target temperatures

AU - Dankiewicz, Josef

AU - Nielsen, Niklas

AU - Linder, Adam

AU - Kuiper, Michael

AU - Wise, Matthew P

AU - Cronberg, Tobias

AU - Erlinge, David

AU - Gasche, Yvan

AU - Harmon, Matthew B

AU - Hassager, Christian

AU - Horn, Janneke

AU - Kjaergaard, Jesper

AU - Pellis, Tommaso

AU - Stammet, Pascal

AU - Undén, Johan

AU - Wanscher, Michael

AU - Wetterslev, Jørn

AU - Åneman, Anders

AU - Ullén, Susann

AU - Juffermans, Nicole P

AU - Friberg, Hans

AU - TTM trial investigators

N1 - Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

PY - 2017/4/1

Y1 - 2017/4/1

N2 - Background It has been suggested that target temperature management (TTM) increases the probability of infectious complications after cardiac arrest. We aimed to compare the incidence of pneumonia, severe sepsis and septic shock after out-of-hospital cardiac arrest (OHCA) in patients with two target temperatures and to describe changes in biomarkers and possible mortality associated with these infectious complications. Methods Post-hoc analysis of the TTM-trial which randomized patients resuscitated from OHCA to a target temperature of 33 °C or 36 °C. Prospective data on infectious complications were recorded daily during the ICU-stay. Pneumonia, severe sepsis and septic shock were considered infectious complications. Procalcitonin (PCT) and C-reactive-protein (CRP) levels were measured at 24 h, 48 h and 72 h after cardiac arrest. Results There were 939 patients in the modified intention-to-treat population. Five-hundred patients (53%) developed pneumonia, severe sepsis or septic shock which was associated with mortality in multivariate analysis (Hazard ratio [HR] 1.39; 95%CI 1.13–1.70; p = 0.001). There was no statistically significant difference in the incidence of infectious complications between temperature groups (sub-distribution hazard ratio [SHR] 0.88; 95%CI 0.75–1.03; p = 0.12). PCT and CRP were significantly higher for patients with infections at all times (p < 0.001), but there was considerable overlap. Conclusions Patients who develop pneumonia, severe sepsis or septic shock after OHCA might have an increased mortality. A target temperature of 33 °C after OHCA was not associated with an increased risk of infectious complications compared to a target temperature of 36 °C. PCT and CRP are of limited value for diagnosing infectious complications after cardiac arrest.

AB - Background It has been suggested that target temperature management (TTM) increases the probability of infectious complications after cardiac arrest. We aimed to compare the incidence of pneumonia, severe sepsis and septic shock after out-of-hospital cardiac arrest (OHCA) in patients with two target temperatures and to describe changes in biomarkers and possible mortality associated with these infectious complications. Methods Post-hoc analysis of the TTM-trial which randomized patients resuscitated from OHCA to a target temperature of 33 °C or 36 °C. Prospective data on infectious complications were recorded daily during the ICU-stay. Pneumonia, severe sepsis and septic shock were considered infectious complications. Procalcitonin (PCT) and C-reactive-protein (CRP) levels were measured at 24 h, 48 h and 72 h after cardiac arrest. Results There were 939 patients in the modified intention-to-treat population. Five-hundred patients (53%) developed pneumonia, severe sepsis or septic shock which was associated with mortality in multivariate analysis (Hazard ratio [HR] 1.39; 95%CI 1.13–1.70; p = 0.001). There was no statistically significant difference in the incidence of infectious complications between temperature groups (sub-distribution hazard ratio [SHR] 0.88; 95%CI 0.75–1.03; p = 0.12). PCT and CRP were significantly higher for patients with infections at all times (p < 0.001), but there was considerable overlap. Conclusions Patients who develop pneumonia, severe sepsis or septic shock after OHCA might have an increased mortality. A target temperature of 33 °C after OHCA was not associated with an increased risk of infectious complications compared to a target temperature of 36 °C. PCT and CRP are of limited value for diagnosing infectious complications after cardiac arrest.

KW - Journal Article

U2 - 10.1016/j.resuscitation.2016.12.008

DO - 10.1016/j.resuscitation.2016.12.008

M3 - Journal article

C2 - 27993631

SN - 0300-9572

VL - 113

SP - 70

EP - 76

JO - Resuscitation

JF - Resuscitation

ER -