Time to start of cardiopulmonary resuscitation and the effect of target temperature management at 33°C and 36°C

TY - JOUR

T1 - Time to start of cardiopulmonary resuscitation and the effect of target temperature management at 33°C and 36°C

AU - Dankiewicz, Josef

AU - Friberg, Hans

AU - Bělohlávek, Jan

AU - Walden, Andrew

AU - Hassager, Christian

AU - Cronberg, Tobias

AU - Erlinge, David

AU - Gasche, Yvan

AU - Hovdenes, Jan

AU - Horn, Janneke

AU - Kjaergaard, Jesper

AU - Kuiper, Michael

AU - Pellis, Thomas

AU - Stammet, Pascal

AU - Wanscher, Michael

AU - Wetterslev, Jørn

AU - Wise, Matthew

AU - Åneman, Anders

AU - Nielsen, Niklas

N1 - Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

PY - 2016/2/1

Y1 - 2016/2/1

N2 - 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.

AB - 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.

KW - Journal Article

KW - Research Support, Non-U.S. Gov't

U2 - 10.1016/j.resuscitation.2015.10.013

DO - 10.1016/j.resuscitation.2015.10.013

M3 - Journal article

C2 - 26705972

SN - 0300-9572

VL - 99

SP - 44

EP - 49

JO - Resuscitation

JF - Resuscitation

ER -