• Anders Morten Grejs, Jakob Gjedsted, Kristian Thygesen, Jens Flensted Lassen, Bodil Steen Rasmussen, Anni Nørgaard Jeppesen, Christophe Henri Valdemar Duez, Eldar Søreide, and Hans Kirkegaard.
• Research Center for Emergency Medicine, Aarhus University Hospital, Denmark; Department of Anesthesiology and Intensive Care Medicine, Aarhus University Hospital, Denmark; Department of Clinical Medicine, Aarhus University, Denmark. Electronic address: anders.grejs@dadlnet.dk.
• Am. J. Med. 2017 Jan 1; 130 (1): 37-46.

AimThe aim of this study is to evaluate the extent of myocardial injury by cardiac biomarkers during prolonged targeted temperature management of 24 hours vs 48 hours after out-of-hospital cardiac arrest.MethodsThis randomized Scandinavian multicenter study compares the extent of myocardial injury quantified by area under the curve (AUC) of cardiac biomarkers during prolonged targeted temperature management at 33°C ± 1°C of 24 hours and 48 hours, respectively. Through a period of 2.5 years, 161 comatose out-of-hospital cardiac arrest patients were randomized to targeted temperature management for 24 hours (n = 77) or 48 hours (n = 84). The AUC was calculated using both high-sensitivity cardiac troponin T (hs-cTnTAUC) and creatine kinase-myocardial band (CK-MBAUC) that were based upon measurements of these biomarkers every 6 hours upon admission until 96 hours after reaching target temperature.ResultsThe median hs-cTnTAUC of 33,827 ng/L/h (interquartile range [IQR] 11,366-117,690) of targeted temperature management at 24 hours did not differ significantly from that of 28,973 ng/L/h (IQR 10,656-163,655) at 48 hours. In contrast, the median CK-MBAUC of 1829 μg/L/h (IQR 800-6799) during targeted temperature management at 24 hours was significantly lower than that of 2428 μg/L/h (IQR 1163-10,906) within targeted temperature management at 48 hours, P <.05.ConclusionThis study of comatose out-of-hospital cardiac arrest survivors showed no difference between the extents of myocardial injury estimated by hs-cTnTAUC of prolonged targeted temperature management of 48 hours vs 24 hours, although the CK-MBAUC was significantly higher during 48 hours vs 24 hours. Hence, it seems unlikely that the duration of targeted temperature management has a beneficial effect on the extent of myocardial injury after out-of-hospital cardiac arrest, and may even have a worsening effect.Copyright © 2016 Elsevier Inc. All rights reserved.

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