Therapeutic hypothermia and temperature management
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Ther Hypothermia Temp Manag · Sep 2020
Copeptin as a Prognostic Marker in Prolonged Targeted Temperature Management After Out-of-Hospital Cardiac Arrest.
The aim was to investigate blood concentrations of copeptin and the prognostication in 24 versus 48 hours of targeted temperature management (TTM) in patients resuscitated after out-of-hospital cardiac arrest. This is an exploratory biomarker substudy of the trial entitled; "Targeted temperature management for 48 vs 24 hours and neurologic outcome after out-of-hospital-cardiac-arrest: A randomized clinical trial." Patients were randomized to target temperature of 33°C ± 1°C for 24 (TTM24) or 48 (TTM48) hours. The primary outcome was copeptin concentrations compared with TTM at admission, 24, 48, and 72 hours (t24, t48, and t72) after reaching target temperature. ⋯ Copeptin levels were not significantly different in noncerebral compared with cerebral causes at admission: p = 0.41, t24: p = 0.52, t48: p = 0.15, and t72: p = 0.38. There were no differences in the level of copeptin in TTM24 versus TTM48. Blood concentrations of copeptin were associated with CPC at 6 months, and no association between levels of copeptin and cerebral versus noncerebral causes of death was observed.
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Ther Hypothermia Temp Manag · Sep 2020
Observational StudyInteraction Effects Between Targeted Temperature Management and Hypertension on Survival Outcomes After Out-of-Hospital Cardiac Arrest: A National Observational Study from 2009 to 2016.
Targeted temperature management (TTM) has been used to improve neurological recovery in comatose patients after out-of-hospital cardiac arrest (OHCA). Hypertension (HTN) existing before a cardiac arrest represents a risk of OHCA, but it is not known whether it affects neurological prognosis. This study aimed at investigating the effect of TTM on neurological recovery in OHCA patients with or without underlying HTN. ⋯ In the interaction model, the AOR of TTM for good neurological recovery was 1.87 (1.26-2.76) in patients without HTN and 0.87 (0.75-1.02) in patients with HTN. The underlying HTN modified the effect of TTM on neurological outcomes for OHCA patients. TTM is associated with good neurological recovery in patients without HTN, but not in patients with HTN.
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Ther Hypothermia Temp Manag · Sep 2020
Targeted Temperature Management for In-Hospital Cardiac Arrest: 6 Years of Experience.
Targeted temperature management (TTM) is widely used for postcardiac arrest management of patients with out-of-hospital cardiac arrest. However, the use of TTM for patients with in-hospital cardiac arrest (IHCA) is controversial. The aim of this study was to investigate the role of TTM in the management of patients with IHCA. ⋯ In this subgroup, the TTM patients had poorer neurological outcomes at discharge (GP-CPC score 1-2) than the SSC patients (1/26 in the TTM group [3.8%] vs. 57/154 in the SSC group [37%]; p = 0.001). TTM was not associated with better 28-day survival than usual care among the patients with IHCA in this study, and the TTM patients had less favorable neurological outcomes at discharge. Randomized clinical trials are needed to assess the efficacy of TTM for IHCA patients.