• Critical care medicine · Feb 2022

    Targeted Temperature Management in Out-of-Hospital Cardiac Arrest With Shockable Rhythm: A Post Hoc Analysis of the Coronary Angiography After Cardiac Arrest Trial.

    • Eva M Spoormans, Jorrit S Lemkes, Gladys N Janssens, Nina W van der Hoeven, JewbaliLucia S DLSDDepartment of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands., Eric A Dubois, Martijn Meuwissen, Tom A Rijpstra, Hans A Bosker, Michiel J Blans, Gabe B Bleeker, Remon Baak, Georgios J Vlachojannis, EikemansBob J WBJWDepartment of Intensive Care Medicine, Maasstad Hospital, Rotterdam, The Netherlands., GirbesArmand R JARJDepartment of Intensive Care Medicine, Amsterdam University Medical Center, location VUmc, Amsterdam, The Netherlands., Pim van der Harst, van der HorstIwan C CICCDepartment of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands.Department of Intensive Care Medicine, Maastricht University Medical Center, University Maastricht, Maastricht, The Netherlands., Michiel Voskuil, Joris J van der Heijden, Albertus Beishuizen, Martin Stoel, Cyril Camaro, Hans van der Hoeven, José P Henriques, VlaarAlexander P JAPJDepartment of Intensive Care Medicine, Amsterdam University Medical Center, location AMC, Amsterdam, The Netherlands., Maarten A Vink, Bas van den Bogaard, Ton A C M Heestermans, Wouter de Ruijter, DelnoijThijs S RTSRDepartment of Intensive Care Medicine, Maastricht University Medical Center, University Maastricht, Maastricht, The Netherlands., CrijnsHarry J G MHJGMDepartment of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands., JessurunGillian A JGAJDepartment of Cardiology, Scheper Hospital, Emmen, The Netherlands., Pranobe V Oemrawsingh, Marcel T M Gosselink, Koos Plomp, Michael Magro, Peter M van de Ven, Niels van Royen, and ElbersPaul W GPWGDepartment of Intensive Care Medicine, Amsterdam University Medical Center, location VUmc, Amsterdam, The Netherlands..
    • Department of Cardiology, Amsterdam University Medical Center, location VUmc, Amsterdam, The Netherlands.
    • Crit. Care Med. 2022 Feb 1; 50 (2): e129-e142.

    ObjectivesThe optimal targeted temperature in patients with shockable rhythm is unclear, and current guidelines recommend targeted temperature management with a correspondingly wide range between 32°C and 36°C. Our aim was to study survival and neurologic outcome associated with targeted temperature management strategy in postarrest patients with initial shockable rhythm.DesignObservational substudy of the Coronary Angiography after Cardiac Arrest without ST-segment Elevation trial.SettingNineteen hospitals in The Netherlands.PatientsThe Coronary Angiography after Cardiac Arrest trial randomized successfully resuscitated patients with shockable rhythm and absence of ST-segment elevation to a strategy of immediate or delayed coronary angiography. In this substudy, 459 patients treated with mild therapeutic hypothermia (32.0-34.0°C) or targeted normothermia (36.0-37.0°C) were included. Allocation to targeted temperature management strategy was at the discretion of the physician.InterventionsNone.Measurements And Main ResultsAfter 90 days, 171 patients (63.6%) in the mild therapeutic hypothermia group and 129 (67.9%) in the targeted normothermia group were alive (hazard ratio, 0.86 [95% CI, 0.62-1.18]; log-rank p = 0.35; adjusted odds ratio, 0.89; 95% CI, 0.45-1.72). Patients in the mild therapeutic hypothermia group had longer ICU stay (4 d [3-7 d] vs 3 d [2-5 d]; ratio of geometric means, 1.32; 95% CI, 1.15-1.51), lower blood pressures, higher lactate levels, and increased need for inotropic support. Cerebral Performance Category scores at ICU discharge and 90-day follow-up and patient-reported Mental and Physical Health Scores at 1 year were similar in the two groups.ConclusionsIn the context of out-of-hospital cardiac arrest with shockable rhythm and no ST-elevation, treatment with mild therapeutic hypothermia was not associated with improved 90-day survival compared with targeted normothermia. Neurologic outcomes at 90 days as well as patient-reported Mental and Physical Health Scores at 1 year did not differ between the groups.Copyright © 2021 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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