Therapeutic hypothermia and temperature management
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Ther Hypothermia Temp Manag · Dec 2020
Temporal Changes in Targeted Temperature Management for Out-of-Hospital Cardiac Arrest-Examining the Effect of the Targeted Temperature Management Trial: A Retrospective Cohort Study.
Targeted temperature management (TTM) is recommended after out-of-hospital cardiac arrest (OHCA). However, interpretation of the evidence and translation into clinical practice, to realize benefits to patient outcomes may be inconsistent. This study aims to compare compliance with the recommended targeted temperatures and the use of intravascular temperature management (IVTM), as well as 90-day survival, before and after publication of the TTM trial. ⋯ Ninety-day survival was 54.4% in the pre-TTM cohort and 44.0% post-TTM, (odds ratio 1.52 [0.96-2.40], p = 0.083). Adherence with recommended TTM decreased significantly following publication of the TTM trial and this was explained by a significant decrease in IVTM use. However, this concerning trend did not result in a statistically significant difference in survival.
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Ther Hypothermia Temp Manag · Dec 2020
Optimal Hemodynamic Parameter to Predict the Neurological Outcome in Out-of-Hospital Cardiac Arrest Survivors Treated with Target Temperature Management.
Current guidelines suggest the maintenance of systolic blood pressure (SBP) at >90 mmHg and mean arterial pressure (MAP) at >65 mmHg in postcardiac arrest patients. There remains a lack of clarity regarding optimal values and timing of blood pressure parameters associated with the improvement of neurologic outcome. We investigated the association of time-weighted average (TWA) blood pressure parameters with favorable neurological outcome (FO) in postcardiac arrest patients. ⋯ Among them, MSI, especially at 6 hours, had the highest area under the curve for prediction of FO (0.685; 95% confidence interval: 0.597-0.772, p < 0.001). Also, MSI <1.0 had a sensitivity of 64.7%, a specificity of 64.2% to predict FO. In comatose survivors of OHCA with TTM, MSI at 6 hours after ROSC had the highest prognostic value for neurologic outcome among blood pressure parameters.