Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Jul 1;3(7):e208215.
doi: 10.1001/jamanetworkopen.2020.8215.

Association of Initial Illness Severity and Outcomes After Cardiac Arrest With Targeted Temperature Management at 36 °C or 33 °C

Clifton W Callaway  1 , Patrick J Coppler  1 , John Faro  1 , Jacob S Puyana  1 , Pawan Solanki  1 , Cameron Dezfulian  1 , Ankur A Doshi  1 , Jonathan Elmer  1 , Adam Frisch  1 , Francis X Guyette  1 , Masashi Okubo  1 , Jon C Rittenberger  1 , Alexandra Weissman  1
Affiliations

Association of Initial Illness Severity and Outcomes After Cardiac Arrest With Targeted Temperature Management at 36 °C or 33 °C

Clifton W Callaway et al. JAMA Netw Open. .

Abstract

Importance: It is uncertain what the optimal target temperature is for targeted temperature management (TTM) in patients who are comatose following cardiac arrest.

Objective: To examine whether illness severity is associated with changes in the association between target temperature and patient outcome.

Design, setting, and participants: This cohort study compared outcomes for 1319 patients who were comatose after cardiac arrest at a single center in Pittsburgh, Pennsylvania, from January 2010 to December 2018. Initial illness severity was based on coma and organ failure scores, presence of severe cerebral edema, and presence of highly malignant electroencephalogram (EEG) after resuscitation.

Exposure: TTM at 36 °C or 33 °C.

Main outcomes and measures: Primary outcome was survival to hospital discharge, and secondary outcomes were modified Rankin Scale and cerebral performance category.

Results: Among 1319 patients, 728 (55.2%) had TTM at 33 °C (451 [62.0%] men; median [interquartile range] age, 61 [50-72] years) and 591 (44.8%) had TTM at 36 °C (353 [59.7%] men; median [interquartile range] age, 59 [48-69] years). Overall, 184 of 187 patients (98.4%) with severe cerebral edema died and 234 of 243 patients (96.3%) with highly malignant EEG died regardless of TTM strategy. Comparing TTM at 33 °C with TTM at 36 °C in 911 patients (69.1%) with neither severe cerebral edema nor highly malignant EEG, survival was lower in patients with mild to moderate coma and no shock (risk difference, -13.8%; 95% CI, -24.4% to -3.2%) but higher in patients with mild to moderate coma and cardiopulmonary failure (risk difference, 21.8%; 95% CI, 5.4% to 38.2%) or with severe coma (risk difference, 9.7%; 95% CI, 4.0% to 15.3%). Interactions were similar for functional outcomes. Most deaths (633 of 968 [65.4%]) resulted after withdrawal of life-sustaining therapies.

Conclusions and relevance: In this study, TTM at 33 °C was associated with better survival than TTM at 36 °C among patients with the most severe post-cardiac arrest illness but without severe cerebral edema or malignant EEG. However, TTM at 36 °C was associated with better survival among patients with mild- to moderate-severity illness.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Callaway reported receiving grants from the National Institutes of Health outside the submitted work and working on American Heart Association and International Guidelines committees for resuscitation guidelines. Dr Dezfulian reported receiving grants from Mallinckrodt Pharmaceuticals outside the submitted work. Dr Elmer reported receiving grants from UPMC Enterprise and the Chuck Nolls Foundation outside the submitted work. Dr Rittenberger reported receiving grants from Hibernaid, the American Heart Association, and BrainCool outside the submitted work. Dr Weissman reported receiving grants from Zoll Foundation outside the submitted work. No other disclosures were reported.

Figures

Figure.
Figure.. Patients Included in this Study
EEG indicates electroencephalogram; TTM, targeted temperature mangagement.
See this image and copyright information in PMC

Comment in

References

    1. Lilja G, Nielsen N, Bro-Jeppesen J, et al. . Return to work and participation in society after out-of-hospital cardiac arrest. Circ Cardiovasc Qual Outcomes. 2018;11(1):e003566. doi:10.1161/CIRCOUTCOMES.117.003566 - DOI - PubMed
    1. Elmer J, Torres C, Aufderheide TP, et al. ; Resuscitation Outcomes Consortium . Association of early withdrawal of life-sustaining therapy for perceived neurological prognosis with mortality after cardiac arrest. Resuscitation. 2016;102:127-135. doi:10.1016/j.resuscitation.2016.01.016 - DOI - PMC - PubMed
    1. Che D, Li L, Kopil CM, Liu Z, Guo W, Neumar RW. Impact of therapeutic hypothermia onset and duration on survival, neurologic function, and neurodegeneration after cardiac arrest. Crit Care Med. 2011;39(6):1423-1430. doi:10.1097/CCM.0b013e318212020a - DOI - PMC - PubMed
    1. Hypothermia after Cardiac Arrest Study Group Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med. 2002;346(8):549-556. doi:10.1056/NEJMoa012689 - DOI - PubMed
    1. Bernard SA, Gray TW, Buist MD, et al. . Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med. 2002;346(8):557-563. doi:10.1056/NEJMoa003289 - DOI - PubMed

Publication types