• Crit Care · Dec 2019

    Temporal trends in the use of targeted temperature management after cardiac arrest and association with outcome: insights from the Paris Sudden Death Expertise Centre.

    • Lascarrou Jean-Baptiste JB http://orcid.org/0000-0003-3706-078X Service de Medecine Intensive Reanimation, Centre Hospitalier Universitaire, 30 Boulev, 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, and SDEC.
    • Service de Medecine Intensive Reanimation, Centre Hospitalier Universitaire, 30 Boulevard Jean Monnet, 44093, Nantes Cedex 9, France. jeanbaptiste.lascarrou@chu-nantes.fr.
    • Crit Care. 2019 Dec 3; 23 (1): 391.

    PurposeRecent 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.MethodsWe 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.ResultsBetween 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.ConclusionsWe 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.

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