Targeted temperature management at 33 versus 36 degrees: A retrospective cohort study

Nicholas J. Johnson, Kyle R. Danielson, Catherine R. Counts, Katelyn Ruark, Sue Scruggs, Catherine L. Hough, Charles Maynard, Michael R. Sayre, David J. Carlbom

Research output: Contribution to journalArticlepeer-review

10 Scopus citations

Abstract

Objectives: To determine the association between targeted temperature management goal temperature of 33°C versus 36°C and neurologic outcome after out-of-hospital cardiac arrest. Design: This was a retrospective, before-and-after, cohort study. Setting: Urban, academic, level 1 trauma center from 2010 to 2017. Patients: Adults with nontraumatic out-of-hospital cardiac arrest who received targeted temperature management. Interventions: Our primary exposure was targeted temperature management goal temperature, which was changed from 33°C to 36°C in April of 2014 at the study hospital. Primary outcome was neurologically intact survival to discharge. Secondary outcomes included hospital mortality and care processes. Measurements and Main Results: Of 782 out-of-hospital cardiac arrest patients transported to the study hospital, 453 (58%) received targeted temperature management. Of these, 258 (57%) were treated during the 33°C period (targeted temperature management 33°C) and 195 (43%) were treated during the 36°C period (targeted temperature management 36°C). Patients treated during targeted temperature management 33°C were older (57 vs 52 yr; p < 0.05) and had more arrests of cardiac etiology (45% vs 35%; p < 0.05), but otherwise had similar baseline characteristics, including initial cardiac rhythm. A total of 40% of patients treated during targeted temperature management 33°C survived with favorable neurologic outcome, compared with 30% in the targeted temperature management 36°C group (p < 0.05). After adjustment for demographic and cardiac arrest characteristics, targeted temperature management 33°C was associated with increased odds of neurologically intact survival to discharge (odds ratio, 1.79; 95% CI, 1.09-2.94). Targeted temperature management 33°C was not associated with significantly improved hospital mortality. Targeted temperature management was implemented faster (1.9 vs 3.5 hr from 911 call; p < 0.001) and more frequently in the emergency department during the targeted temperature management 33°C period (87% vs 55%; p < 0.001). Conclusions: Comatose, adult out-of-hospital cardiac arrest patients treated during the targeted temperature management 33°C period had higher odds of neurologically intact survival to hospital discharge compared with those treated during the targeted temperature management 36°C period. There was no significant difference in hospital mortality.

Original languageEnglish (US)
Pages (from-to)362-369
Number of pages8
JournalCritical care medicine
DOIs
StateAccepted/In press - 2020
Externally publishedYes

Keywords

  • Cardiac arrest
  • Out-of-hospital cardiac arrest
  • Targeted temperature management
  • Therapeutic hypothermia

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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