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, Lucia S D Jewbali, Eric A Dubois, Martijn Meuwissen, Tom A Rijpstra, Hans A Bosker, Michiel J Blans, Gabe B Bleeker, Remon Baak, Georgios J Vlachojannis, Bob J W Eikemans, Armand R J Girbes, Pim van der Harst, Iwan C C van der Horst, Michiel Voskuil, Joris J van der Heijden, Albertus BeishuizenMartin Stoel, Cyril Camaro, Hans van der Hoeven, José P Henriques, Alexander P J Vlaar, Maarten A Vink, Bas van den Bogaard, Ton A C M Heestermans, Wouter de Ruijter, Thijs S R Delnoij, Harry J G M Crijns, Gillian A J Jessurun, Pranobe V Oemrawsingh, Marcel T M Gosselink, Koos Plomp, Michael Magro, Peter M van de Ven, Niels van Royen, Paul W G Elbers

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Abstract

OBJECTIVES: The 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.

DESIGN: Observational substudy of the Coronary Angiography after Cardiac Arrest without ST-segment Elevation trial.

SETTING: Nineteen hospitals in The Netherlands.

PATIENTS: The 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.

INTERVENTIONS: None.

MEASUREMENTS AND MAIN RESULTS: After 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.

CONCLUSIONS: In 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.

Original languageEnglish
JournalCritical Care Medicine
DOIs
Publication statusE-pub ahead of print - 22 Sep 2021

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