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. 2019 Dec 3;23(1):391.
doi: 10.1186/s13054-019-2677-1.

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

Jean-Baptiste Lascarrou  1   2   3   4 , Florence Dumas  5   6   7 , Wulfran Bougouin  5   6   8 , Richard Chocron  5   6   7 , Frankie Beganton  5   6 , Stephane Legriel  5   6   8   9 , Nadia Aissaoui  5   6   8   10 , Nicolas Deye  5   6   8   11 , Lionel Lamhaut  5   6   8   12 , Daniel Jost  5   13 , Antoine Vieillard-Baron  5   14 , Eloi Marijon  5   6 , Xavier Jouven  5   6 , Alain Cariou  5   6   8   15 ; SDEC
Collaborators, Affiliations

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

Jean-Baptiste Lascarrou et al. Crit Care. .

Abstract

Purpose: Recent 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.

Methods: We 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.

Results: Between 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.

Conclusions: We 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.

Keywords: Cardiac arrest; Induced hypothermia; Neurological outcome; Targeted temperature management.

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Conflict of interest statement

AC received fees for lectures from C.R. Bard (Murray Hill, NJ, USA). The other authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Changes in TTM use over time according to initial cardiac rhythm
Fig. 2
Fig. 2
Changes in characteristics and outcome according to periods of segmented regression analysis
Fig. 3
Fig. 3
Changes in neurological outcome according to periods of segmented regression analysis
See this image and copyright information in PMC

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