Temporal Trends in the Use of Targeted Temperature Management After Cardiac Arrest and Association with Outcome: Insights from the Paris Sudden Death Expertise Centre

Overview

Journal Crit Care

Specialty Critical Care

Date 2019 Dec 5

PMID 31796127

Citations 8

Authors

Jean-Baptiste Lascarrou

Florence Dumas

Wulfran Bougouin

Richard Chocron

Frankie Beganton

Stephane Legriel

Nadia Aissaoui

Nicolas Deye

Lionel Lamhaut

Daniel Jost

Antoine Vieillard-Baron

Eloi Marijon

Xavier Jouven

Alain Cariou

Affiliations

Soon will be listed here.

Abstract

Purpose: Recent doubts regarding the efficacy may have resulted in a loss of interest for targeted temperature management (TTM) in comatose cardiac arrest (CA) patients, with uncertain consequences on outcome. We aimed to identify a change in TTM use and to assess the relationship between this change and neurological outcome.

Methods: We used Utstein data prospectively collected in the Sudden Death Expertise Center (SDEC) registry (capturing CA data from all secondary and tertiary hospitals located in the Great Paris area, France) between May 2011 and December 2017. All cases of non-traumatic OHCA patients with stable return of spontaneous circulation (ROSC) were included. After adjustment for potential confounders, we assessed the relationship between changes over time in the use of TTM and neurological recovery at discharge using the Cerebral Performance Categories (CPC) scale.

Results: Between May 2011 and December 2017, 3925 patients were retained in the analysis, of whom 1847 (47%) received TTM. The rate of good neurological outcome at discharge (CPC 1 or 2) was higher in TTM patients as compared with no TTM (33% vs 15%, P < 0.001). Gender, age, and location of CA did not change over the years. Bystander CPR increased from 55% in 2011 to 73% in 2017 (P < 0.001) and patients with a no-flow time longer than 3 min decreased from 53 to 38% (P < 0.001). The use of TTM decreased from 55% in 2011 to 37% in 2017 (P < 0.001). Meanwhile, the rate of patients with good neurological recovery remained stable (19 to 23%, P = 0.76). After adjustment, year of CA occurrence was not associated with outcome.

Conclusions: We report a progressive decrease in the use of TTM in post-cardiac arrest patients over the recent years. During this period, neurological outcome remained stable, despite an increase in bystander-initiated resuscitation and a decrease in "no flow" duration.

Citing Articles

Opinions and attitudes toward targeted temperature management in the emergency department and intensive care unit in a developing country: a survey study.

Bakhsh A, Alotaibi H, Alothman S, Alothman A, Alothman R, Alsulami A World J Emerg Med. 2023; 14(2):138-142.

PMID: 36911059 PMC: 9999127. DOI: 10.5847/wjem.j.1920-8642.2023.030.

Targeted temperature management with hypothermia for comatose patients after cardiac arrest.

Callaway C Clin Exp Emerg Med. 2023; 10(1):5-17.

PMID: 36796779 PMC: 10090724. DOI: 10.15441/ceem.23.012.

Through the Looking Glass: The Paradoxical Evolution of Targeted Temperature Management for Comatose Survivors of Cardiac Arrest.

DAmato S, Kimberly W, Mayer S Neurotherapeutics. 2022; 19(6):1869-1877.

PMID: 36253510 PMC: 9723025. DOI: 10.1007/s13311-022-01315-7.

[Targeted temperature management after cardiac arrest : What is new?].

Kainz E, Fischer M Anaesthesist. 2022; 71(2):85-93.

PMID: 35050390 DOI: 10.1007/s00101-022-01091-1.

Impact of rewarming rate on interleukin-6 levels in patients with shockable cardiac arrest receiving targeted temperature management at 33 °C: the ISOCRATE pilot randomized controlled trial.

Lascarrou J, Guichard E, Reignier J, Le Gouge A, Pouplet C, Martin S Crit Care. 2021; 25(1):434.

PMID: 34920723 PMC: 8680374. DOI: 10.1186/s13054-021-03842-9.

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