Impact of time to return of spontaneous circulation on neuroprotective effect of targeted temperature management at 33 or 36 degrees in comatose survivors of out-of hospital cardiac arrest

Jesper Kjaergaard; Niklas Nielsen; Matilde Winther-Jensen; Michael Wanscher; Tommaso Pellis; Michael Kuiper; Jakob Hartvig Thomsen; Jørn Wetterslev; Tobias Cronberg; John Bro-Jeppesen; David Erlinge; Hans Friberg; Helle Søholm; Yvan Gasche; Janneke Horn; Jan Hovdenes; Pascal Stammet; Matthew P Wise; Anders Åneman; Christian Hassager

doi:10.1016/j.resuscitation.2015.06.021

Impact of time to return of spontaneous circulation on neuroprotective effect of targeted temperature management at 33 or 36 degrees in comatose survivors of out-of hospital cardiac arrest

Jesper Kjaergaard, Niklas Nielsen, Matilde Winther-Jensen, Michael Wanscher, Tommaso Pellis, Michael Kuiper, Jakob Hartvig Thomsen, Jørn Wetterslev, Tobias Cronberg, John Bro-Jeppesen, David Erlinge, Hans Friberg, Helle Søholm, Yvan Gasche, Janneke Horn, Jan Hovdenes, Pascal Stammet, Matthew P Wise, Anders Åneman, Christian Hassager

34 Citations (Scopus)

Abstract

AIM: Time to Return of Spontaneous Circulation (ROSC) has a plausible relation to severity of hypoxic injury before and during resuscitation in Out-of-Hospital Cardiac Arrest (OHCA), and has consistently been associated with adverse outcome. The effect of Targeted Temperature Management (TTM) may not be similar over the full spectrum of time to ROSC. This study investigated the possible beneficial effect of targeting 33°C over 36°C on the prognostic importance of time to ROSC.

METHODS: In predefined sub-study of the TTM-trial (NEJM 2013) we investigated the relationship between time to ROSC, level of TTM and mortality and neurological outcome as assessed by the Cerebral Performance Category (CPC) scale and modified Rankin Scale (mRS) after 180 days.

RESULTS: Prolonged time to ROSC was significantly associated with increased mortality with a hazard ratio (HR) of 1.02 per minute (95% CI 1.01-1.02). Level of TTM did not modify the association of time to ROSC and mortality, pinteraction=0.85. Prolonged time to ROSC was associated with reduced odds of surviving with a favorable neurological outcome for CPC (p=0.008 for CPC 1-2) and mRS (p=0.17, mRS 0-3) with no significant interaction with level of TTM.

CONCLUSION: Time to ROSC remains a significant prognostic factor in comatose OHCA patients with regards to risk of death and risk of adverse neurological outcome. For any time to ROSC, targeting 33°C in TTM was not associated with benefit with regards to reducing mortality or risk of adverse neurological outcome compared to targeting 36°C.

Original language	English
Journal	Resuscitation
Volume	96
Pages (from-to)	310-6
Number of pages	7
ISSN	0300-9572
DOIs	https://doi.org/10.1016/j.resuscitation.2015.06.021
Publication status	Published - Nov 2015

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Kjaergaard, J., Nielsen, N., Winther-Jensen, M., Wanscher, M., Pellis, T., Kuiper, M., Hartvig Thomsen, J., Wetterslev, J., Cronberg, T., Bro-Jeppesen, J., Erlinge, D., Friberg, H., Søholm, H., Gasche, Y., Horn, J., Hovdenes, J., Stammet, P., Wise, M. P., Åneman, A., & Hassager, C. (2015). Impact of time to return of spontaneous circulation on neuroprotective effect of targeted temperature management at 33 or 36 degrees in comatose survivors of out-of hospital cardiac arrest. Resuscitation, 96, 310-6. https://doi.org/10.1016/j.resuscitation.2015.06.021

Impact of time to return of spontaneous circulation on neuroprotective effect of targeted temperature management at 33 or 36 degrees in comatose survivors of out-of hospital cardiac arrest. / Kjaergaard, Jesper; Nielsen, Niklas; Winther-Jensen, Matilde et al.

In: Resuscitation, Vol. 96, 11.2015, p. 310-6.

Research output: Contribution to journal › Journal article › Research › peer-review

Kjaergaard, J, Nielsen, N, Winther-Jensen, M, Wanscher, M, Pellis, T, Kuiper, M, Hartvig Thomsen, J, Wetterslev, J, Cronberg, T, Bro-Jeppesen, J, Erlinge, D, Friberg, H, Søholm, H, Gasche, Y, Horn, J, Hovdenes, J, Stammet, P, Wise, MP, Åneman, A & Hassager, C 2015, 'Impact of time to return of spontaneous circulation on neuroprotective effect of targeted temperature management at 33 or 36 degrees in comatose survivors of out-of hospital cardiac arrest', Resuscitation, vol. 96, pp. 310-6. https://doi.org/10.1016/j.resuscitation.2015.06.021

@article{3b7f9f9232244d4baa9b83d3144d1cc4,

title = "Impact of time to return of spontaneous circulation on neuroprotective effect of targeted temperature management at 33 or 36 degrees in comatose survivors of out-of hospital cardiac arrest",

abstract = "AIM: Time to Return of Spontaneous Circulation (ROSC) has a plausible relation to severity of hypoxic injury before and during resuscitation in Out-of-Hospital Cardiac Arrest (OHCA), and has consistently been associated with adverse outcome. The effect of Targeted Temperature Management (TTM) may not be similar over the full spectrum of time to ROSC. This study investigated the possible beneficial effect of targeting 33°C over 36°C on the prognostic importance of time to ROSC.METHODS: In predefined sub-study of the TTM-trial (NEJM 2013) we investigated the relationship between time to ROSC, level of TTM and mortality and neurological outcome as assessed by the Cerebral Performance Category (CPC) scale and modified Rankin Scale (mRS) after 180 days.RESULTS: Prolonged time to ROSC was significantly associated with increased mortality with a hazard ratio (HR) of 1.02 per minute (95% CI 1.01-1.02). Level of TTM did not modify the association of time to ROSC and mortality, pinteraction=0.85. Prolonged time to ROSC was associated with reduced odds of surviving with a favorable neurological outcome for CPC (p=0.008 for CPC 1-2) and mRS (p=0.17, mRS 0-3) with no significant interaction with level of TTM.CONCLUSION: Time to ROSC remains a significant prognostic factor in comatose OHCA patients with regards to risk of death and risk of adverse neurological outcome. For any time to ROSC, targeting 33°C in TTM was not associated with benefit with regards to reducing mortality or risk of adverse neurological outcome compared to targeting 36°C.",

author = "Jesper Kjaergaard and Niklas Nielsen and Matilde Winther-Jensen and Michael Wanscher and Tommaso Pellis and Michael Kuiper and {Hartvig Thomsen}, Jakob and J{\o}rn Wetterslev and Tobias Cronberg and John Bro-Jeppesen and David Erlinge and Hans Friberg and Helle S{\o}holm and Yvan Gasche and Janneke Horn and Jan Hovdenes and Pascal Stammet and Wise, {Matthew P} and Anders {\AA}neman and Christian Hassager",

year = "2015",

month = nov,

doi = "10.1016/j.resuscitation.2015.06.021",

language = "English",

volume = "96",

pages = "310--6",

journal = "Resuscitation",

issn = "0300-9572",

publisher = "Elsevier Ireland Ltd",

}

TY - JOUR

T1 - Impact of time to return of spontaneous circulation on neuroprotective effect of targeted temperature management at 33 or 36 degrees in comatose survivors of out-of hospital cardiac arrest

AU - Kjaergaard, Jesper

AU - Nielsen, Niklas

AU - Winther-Jensen, Matilde

AU - Wanscher, Michael

AU - Pellis, Tommaso

AU - Kuiper, Michael

AU - Hartvig Thomsen, Jakob

AU - Wetterslev, Jørn

AU - Cronberg, Tobias

AU - Bro-Jeppesen, John

AU - Erlinge, David

AU - Friberg, Hans

AU - Søholm, Helle

AU - Gasche, Yvan

AU - Horn, Janneke

AU - Hovdenes, Jan

AU - Stammet, Pascal

AU - Wise, Matthew P

AU - Åneman, Anders

AU - Hassager, Christian

PY - 2015/11

Y1 - 2015/11

N2 - AIM: Time to Return of Spontaneous Circulation (ROSC) has a plausible relation to severity of hypoxic injury before and during resuscitation in Out-of-Hospital Cardiac Arrest (OHCA), and has consistently been associated with adverse outcome. The effect of Targeted Temperature Management (TTM) may not be similar over the full spectrum of time to ROSC. This study investigated the possible beneficial effect of targeting 33°C over 36°C on the prognostic importance of time to ROSC.METHODS: In predefined sub-study of the TTM-trial (NEJM 2013) we investigated the relationship between time to ROSC, level of TTM and mortality and neurological outcome as assessed by the Cerebral Performance Category (CPC) scale and modified Rankin Scale (mRS) after 180 days.RESULTS: Prolonged time to ROSC was significantly associated with increased mortality with a hazard ratio (HR) of 1.02 per minute (95% CI 1.01-1.02). Level of TTM did not modify the association of time to ROSC and mortality, pinteraction=0.85. Prolonged time to ROSC was associated with reduced odds of surviving with a favorable neurological outcome for CPC (p=0.008 for CPC 1-2) and mRS (p=0.17, mRS 0-3) with no significant interaction with level of TTM.CONCLUSION: Time to ROSC remains a significant prognostic factor in comatose OHCA patients with regards to risk of death and risk of adverse neurological outcome. For any time to ROSC, targeting 33°C in TTM was not associated with benefit with regards to reducing mortality or risk of adverse neurological outcome compared to targeting 36°C.

AB - AIM: Time to Return of Spontaneous Circulation (ROSC) has a plausible relation to severity of hypoxic injury before and during resuscitation in Out-of-Hospital Cardiac Arrest (OHCA), and has consistently been associated with adverse outcome. The effect of Targeted Temperature Management (TTM) may not be similar over the full spectrum of time to ROSC. This study investigated the possible beneficial effect of targeting 33°C over 36°C on the prognostic importance of time to ROSC.METHODS: In predefined sub-study of the TTM-trial (NEJM 2013) we investigated the relationship between time to ROSC, level of TTM and mortality and neurological outcome as assessed by the Cerebral Performance Category (CPC) scale and modified Rankin Scale (mRS) after 180 days.RESULTS: Prolonged time to ROSC was significantly associated with increased mortality with a hazard ratio (HR) of 1.02 per minute (95% CI 1.01-1.02). Level of TTM did not modify the association of time to ROSC and mortality, pinteraction=0.85. Prolonged time to ROSC was associated with reduced odds of surviving with a favorable neurological outcome for CPC (p=0.008 for CPC 1-2) and mRS (p=0.17, mRS 0-3) with no significant interaction with level of TTM.CONCLUSION: Time to ROSC remains a significant prognostic factor in comatose OHCA patients with regards to risk of death and risk of adverse neurological outcome. For any time to ROSC, targeting 33°C in TTM was not associated with benefit with regards to reducing mortality or risk of adverse neurological outcome compared to targeting 36°C.

U2 - 10.1016/j.resuscitation.2015.06.021

DO - 10.1016/j.resuscitation.2015.06.021

M3 - Journal article

C2 - 26159609

SN - 0300-9572

VL - 96

SP - 310

EP - 316

JO - Resuscitation

JF - Resuscitation

ER -

Impact of time to return of spontaneous circulation on neuroprotective effect of targeted temperature management at 33 or 36 degrees in comatose survivors of out-of hospital cardiac arrest

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