Regional Variation in Temperature Control After Out-of-hospital Cardiac Arrest

Overview

Journal Resusc Plus

Date 2025 Feb 20

PMID 39974626

Authors

Iana Meitlis

Jane Hall

Navya Gunaje

Megin Parayil

Betty Y Yang

Kyle Danielson

Catherine R Counts

Christopher Drucker

Charles Maynard

Thomas D Rea

Peter J Kudenchuk

Michael R Sayre

Nicholas J Johnson

Affiliations

Soon will be listed here.

Abstract

Introduction: We evaluated hospitals for variation in temperature control (TC) use after out-of-hospital cardiac arrest (OHCA) in a regional emergency medical services system and assessed association of hospital-level TC utilization with survival.

Methods: A retrospective cohort study of adults with non-traumatic OHCA who survived to hospital admission from 2016 to 2018 in King County, Washington. Hospitals with < 80 OHCA cases were excluded. Primary exposure was hospital-level proportion of TC. Measured outcomes were survival to hospital discharge and neurologically favorable survival (defined as Cerebral Performance Category 1 or 2). Logistic regression modeling clustered patients by treating hospital and evaluated associations between TC and outcomes with covariate adjustment.

Results: Of 1,035 eligible patients admitted to eight hospitals, 69% were male, 38% had an initial shockable rhythm, and 61% had presumed cardiac etiology for OHCA. TC was initiated in 787 patients (74%) and ranged from 57 to 87% across hospitals. Overall, 34% of patients survived neurologically intact, 74% of whom received TC. In the adjusted model, public OHCA location (OR: 1.7 [95% CI 1.3-2.3]), witnessed arrest (OR: 1.6 [1.2-2.2]), and shockable rhythm (OR: 5.5 [3.9-7.8]) were more strongly associated with survival than TC utilization (OR: 0.6 [0.4-0.8]). Similar results were seen for neurologically favorable survival and did not vary significantly by hospital.

Conclusions: Hospital-level TC utilization was not associated with improved survival or neurologically favorable survival after OHCA. Future studies should examine which aspects of the post-cardiac arrest care bundle most strongly influence outcomes.

References

Granfeldt A, Holmberg M, Nolan J, Soar J, Andersen L . Targeted temperature management in adult cardiac arrest: Systematic review and meta-analysis. Resuscitation. 2021; 167:160-172. DOI: 10.1016/j.resuscitation.2021.08.040. View

Dillenbeck E, Hollenberg J, Holzer M, Busch H, Nichol G, Radsel P . The design of the PRINCESS 2 trial: A randomized trial to study the impact of ultrafast hypothermia on complete neurologic recovery after out-of-hospital cardiac arrest with initial shockable rhythm. Am Heart J. 2024; 271:97-108. DOI: 10.1016/j.ahj.2024.02.020. View

Hermel M, Bosson N, Fang A, French W, Niemann J, Sung G . Implementation of Targeted Temperature Management After Out-of-Hospital Cardiac Arrest: Observations From the Los Angeles County Regional System. J Am Heart Assoc. 2020; 9(24):e016652. PMC: 7955369. DOI: 10.1161/JAHA.120.016652. View

Cho S . Using multilevel analysis in patient and organizational outcomes research. Nurs Res. 2003; 52(1):61-5. DOI: 10.1097/00006199-200301000-00010. View

Meaney P, Nadkarni V, Kern K, Indik J, Halperin H, Berg R . Rhythms and outcomes of adult in-hospital cardiac arrest. Crit Care Med. 2009; 38(1):101-8. DOI: 10.1097/CCM.0b013e3181b43282. View

Kudenchuk P, Redshaw J, Stubbs B, Fahrenbruch C, Dumas F, Phelps R . Impact of changes in resuscitation practice on survival and neurological outcome after out-of-hospital cardiac arrest resulting from nonshockable arrhythmias. Circulation. 2012; 125(14):1787-94. DOI: 10.1161/CIRCULATIONAHA.111.064873. View

Phelps R, Dumas F, Maynard C, Silver J, Rea T . Cerebral Performance Category and long-term prognosis following out-of-hospital cardiac arrest. Crit Care Med. 2013; 41(5):1252-7. DOI: 10.1097/CCM.0b013e31827ca975. View

Goh A, Seow J, Lai M, Liu N, Goh Y, Ong M . Association of High-Volume Centers With Survival Outcomes Among Patients With Nontraumatic Out-of-Hospital Cardiac Arrest: A Systematic Review and Meta-Analysis. JAMA Netw Open. 2022; 5(5):e2214639. PMC: 9157264. DOI: 10.1001/jamanetworkopen.2022.14639. View

Morris N, Mazzeffi M, McArdle P, May T, Waldrop G, Perman S . Hispanic/Latino-Serving Hospitals Provide Less Targeted Temperature Management Following Out-of-Hospital Cardiac Arrest. J Am Heart Assoc. 2021; 10(24):e017773. PMC: 9075225. DOI: 10.1161/JAHA.121.023934. View

10.

Nielsen N, Wetterslev J, Cronberg T, Erlinge D, Gasche Y, Hassager C . Targeted temperature management at 33°C versus 36°C after cardiac arrest. N Engl J Med. 2013; 369(23):2197-206. DOI: 10.1056/NEJMoa1310519. View

11.

Olai H, Thorneus G, Watson H, Macleod M, Rhodes J, Friberg H . Meta-analysis of targeted temperature management in animal models of cardiac arrest. Intensive Care Med Exp. 2020; 8(1):3. PMC: 6969098. DOI: 10.1186/s40635-019-0291-9. View

12.

Khera R, Humbert A, Leroux B, Nichol G, Kudenchuk P, Scales D . Hospital Variation in the Utilization and Implementation of Targeted Temperature Management in Out-of-Hospital Cardiac Arrest. Circ Cardiovasc Qual Outcomes. 2018; 11(11):e004829. DOI: 10.1161/CIRCOUTCOMES.118.004829. View

13.

Lascarrou J, Merdji H, Le Gouge A, Colin G, Grillet G, Girardie P . Targeted Temperature Management for Cardiac Arrest with Nonshockable Rhythm. N Engl J Med. 2019; 381(24):2327-2337. DOI: 10.1056/NEJMoa1906661. View

14.

Barbarawi M, Alabdouh A, Barbarawi O, Lakshman H, Alkasasbeh M, Rizk F . Targeted Temperature Management in Cardiac Arrest Patients With an Initial Non-Shockable Rhythm: A Systematic Review and Meta-Analysis. Shock. 2020; 54(5):623-630. DOI: 10.1097/SHK.0000000000001550. View

15.

Cobb L, Fahrenbruch C, Walsh T, Copass M, Olsufka M, Breskin M . Influence of cardiopulmonary resuscitation prior to defibrillation in patients with out-of-hospital ventricular fibrillation. JAMA. 1999; 281(13):1182-8. DOI: 10.1001/jama.281.13.1182. View

16.

Osman M, Munir M, Regner S, Osman K, Benjamin M, Kheiri B . Induced Hypothermia in Patients with Cardiac Arrest and a Non-shockable Rhythm: Meta-analysis and Trial Sequential Analysis. Neurocrit Care. 2020; 34(1):279-286. DOI: 10.1007/s12028-020-01034-x. View

17.

Morris N, Mazzeffi M, McArdle P, May T, Burke J, Bradley S . Women receive less targeted temperature management than men following out-of-hospital cardiac arrest due to early care limitations - A study from the CARES Investigators. Resuscitation. 2021; 169:97-104. DOI: 10.1016/j.resuscitation.2021.10.036. View

18.

Dezfulian C, Orkin A, Maron B, Elmer J, Girotra S, Gladwin M . Opioid-Associated Out-of-Hospital Cardiac Arrest: Distinctive Clinical Features and Implications for Health Care and Public Responses: A Scientific Statement From the American Heart Association. Circulation. 2021; 143(16):e836-e870. DOI: 10.1161/CIR.0000000000000958. View

19.

Counts C, Blackwood J, Winchell R, Drucker C, Jennerich A, Feder S . Emergency Medical Services and Do Not Attempt Resuscitation directives among patients with out-of-hospital cardiac arrest. Resuscitation. 2020; 158:73-78. DOI: 10.1016/j.resuscitation.2020.11.015. View

20.

Chocron R, Fahrenbruch C, Yin L, Guan S, Drucker C, Shin J . Association between functional status at hospital discharge and long-term survival after out-of-hospital-cardiac-arrest. Resuscitation. 2021; 164:30-37. DOI: 10.1016/j.resuscitation.2021.04.031. View