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Targeted temperature management processes and outcomes after out-of-hospital cardiac arrest: an observational cohort study*.

Abstract：

OBJECTIVES:Targeted temperature management has been shown to improve survival with good neurological outcome in patients after out-of-hospital cardiac arrest. The optimal approach to inducing and maintaining targeted temperature management, however, remains uncertain. The objective of this study was to evaluate these processes of care with survival and neurological function in patients after out-of-hospital cardiac arrest. DESIGN:An observational cohort study evaluating the association of targeted temperature management processes with survival and neurological function using bivariate and generalized estimating equation analyses. SETTING:Thirty-two tertiary and community hospitals in eight urban and rural regions of southern Ontario, Canada. PATIENTS:Consecutive adult (≥ 18 yr) patients admitted between November 1, 2007, and January 31, 2012, and who were treated with targeted temperature management following nontraumatic out-of-hospital cardiac arrest. INTERVENTIONS:Evaluate the association of targeted temperature management processes with survival and neurologic function using bivariate and generalized estimating equation analyses. MEASUREMENTS AND MAIN RESULTS:There were 5,770 consecutive out-of-hospital cardiac arrest patients, of whom 747 (12.9%) were eligible and received targeted temperature management. Among patients with available outcome data, 365 of 738 (49.5%) survived to hospital discharge and 241 of 675 (35.7%) had good neurological outcomes. After adjusting for the Utstein variables, a higher temperature prior to initiation of targeted temperature management was associated with improved neurological outcomes (odds ratio, 1.27 per °C; 95% CI, 1.08-1.50; p = 0.004) and survival (odds ratio, 1.26 per °C; 95% CI, 1.09-1.46; p = 0.002). A slower rate of cooling was associated with improved neurological outcomes (odds ratio, 0.74 per °C/hr; 95% CI, 0.57-0.97; p = 0.03) and survival (odds ratio, 0.73 per °C/hr; 95% CI, 0.54-1.00; p = 0.049). CONCLUSIONS:A higher baseline temperature prior to initiation of targeted temperature management and a slower rate of cooling were associated with improved survival and neurological outcomes. This may reflect a complex relationship between the approach to targeted temperature management and the extent of underlying brain injury causing impaired thermoregulation in out-of-hospital cardiac arrest patients.

journal_name

Crit Care Med

journal_title

Critical care medicine

authors

Lin S,Scales DC,Dorian P,Kiss A,Common MR,Brooks SC,Goodman SG,Salciccioli JD,Morrison LJ

doi

10.1097/CCM.0000000000000551

subject

Has Abstract

pub_date

2014-12-01 00:00:00

pages

2565-74

issue

eissn

0090-3493

issn

1530-0293

journal_volume

pub_type

杂志文章,多中心研究

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Targeted temperature management processes and outcomes after out-of-hospital cardiac arrest: an observational cohort study*.